Medicaid and Medicare are both government health programs, but they serve very different populations. Medicare is federal health insurance for people 65 and older and certain people with disabilities, regardless of income. Medicaid is a joint federal-state program that covers low-income individuals and families of any age. As of 2026, roughly 75.7 million Americans are enrolled in Medicaid or CHIP, while 67 million are on Medicare -- and about 12 million people qualify for both at the same time.
Quick Answer: Medicare is based on age (65+) or disability status. Medicaid is based on income. If you are 65+ and have low income, you may qualify for both -- this is called dual eligibility, and it gives you more comprehensive coverage at lower cost.
If you are not sure which program you qualify for, check your eligibility at CoveredUSA -- it takes about 2 minutes and is free.
What Is Medicare?
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It was created in 1965 and is funded primarily through payroll taxes.
Who qualifies for Medicare in 2026?
You qualify for Medicare if you meet one of the following:
- You are 65 years old or older and a U.S. citizen or legal permanent resident (with at least 5 years residency)
- You are under 65 and have received Social Security Disability Insurance (SSDI) for at least 24 consecutive months
- You have End-Stage Renal Disease (ESRD), regardless of age
- You have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig's disease -- Medicare starts the month your SSDI benefits begin, without the 24-month wait
There are no income limits to enroll in Medicare based on age. A millionaire and a minimum-wage worker both qualify at 65.
Medicare Parts A, B, C, and D
Medicare is divided into parts:
| Part | What It Covers | 2026 Standard Cost |
|---|
| Part A | Hospital stays, skilled nursing, hospice | $0 premium if you worked 40+ quarters; $565/month if not |
| Part B | Outpatient care, doctor visits, preventive services | $202.90/month standard premium |
| Part C (Medicare Advantage) | Bundled A+B+D through private insurer | Varies by plan |
| Part D | Prescription drugs | Varies by plan |
Most people pay $0 for Part A because they (or a spouse) paid Medicare taxes for at least 10 years (40 quarters). If you paid 30 to 39 quarters, the 2026 Part A premium drops to $311/month.
The standard Part B premium for 2026 is $202.90/month. Higher-income enrollees pay more through IRMAA (Income-Related Monthly Adjustment Amount) surcharges.
What Is Medicaid?
Medicaid is a joint federal and state program that provides health coverage to people with low incomes. Unlike Medicare, Medicaid eligibility and benefits vary by state -- each state sets its own income limits within federal guidelines.
Who qualifies for Medicaid in 2026?
Medicaid eligibility depends on your state, income, household size, age, and immigration status. The main categories are:
- Adults ages 19 to 64 in states that expanded Medicaid: income at or below 138% of the Federal Poverty Level (FPL)
- Children and pregnant women: often covered at higher income thresholds (up to 200-300% FPL in many states)
- Seniors and people with disabilities: separate eligibility rules apply, often with stricter limits
- Adults in non-expansion states: income limits vary widely; in some states, non-disabled adults without children may not qualify at all
As of 2026, 40 states and Washington D.C. have expanded Medicaid under the ACA. Ten states have not expanded: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.
Medicaid Income Limits for 2026
For Medicaid expansion states, the general income limit for adults is 138% FPL. Here is what that looks like by household size:
| Household Size | 138% FPL (Annual) | 138% FPL (Monthly) |
|---|
| 1 | $20,782 | $1,732 |
| 2 | $28,208 | $2,351 |
| 3 | $35,634 | $2,970 |
| 4 | $43,056 | $3,588 |
| 5 | $50,482 | $4,207 |
For nursing home Medicaid and long-term care in 2026, most states use an income cap of $2,982/month for individuals and $5,964/month for couples.
For a full state-by-state breakdown, see our Medicaid income limits reference page.
Medicaid vs Medicare: Side-by-Side Comparison
| Feature | Medicare | Medicaid |
|---|
| Who it covers | Age 65+, or disabled, or ESRD/ALS | Low-income individuals and families |
| Income requirement | None | Yes -- varies by state |
| Asset requirement | None | Yes, in most cases (varies) |
| Run by | Federal government | State + federal government (jointly) |
| Premiums | Yes (Part B: $202.90/mo standard) | Usually $0 or very low |
| Coverage | Hospital, outpatient, Rx drugs (with Part D) | Hospital, outpatient, long-term care, dental, vision (varies by state) |
| Long-term care | No (only limited skilled nursing) | Yes -- nursing home, home care |
| Dental coverage | Limited | Often included (varies by state) |
| Enrollment | Federal (Social Security/CMS) | State Medicaid agency |
Key Differences to Know
1. Medicare does not cover long-term care. If you need nursing home care or ongoing home health aide services, Medicare covers only short-term skilled nursing (up to 100 days after a qualifying hospital stay). Medicaid is the primary payer for long-term care in the United States.
2. Medicaid pays for dental and vision more often. Adult dental and vision benefits under Medicare are very limited. Many state Medicaid programs include these services, though coverage varies significantly.
3. Medicaid can have estate recovery. States are required to seek repayment from the estates of Medicaid enrollees who were 55 or older and received long-term care services. Medicare does not have estate recovery.
4. Medicare costs more out-of-pocket. Medicare has premiums, deductibles, and copays. Medicaid typically has minimal or no cost-sharing for enrollees below a certain income level.
5. Medicaid varies dramatically by state. A single adult earning $25,000/year qualifies for Medicaid in California but not in Texas. Medicare eligibility is the same in every state.
What Is Dual Eligibility?
If you qualify for both Medicare and Medicaid, you are considered "dual eligible." As of 2026, approximately 12 million Americans are dual eligible. This group tends to be older adults with low incomes, or people with disabilities who have both limited income and qualifying medical conditions.
Dual eligible individuals get the best of both programs:
- Medicare covers most medical costs (hospital, outpatient, Rx drugs)
- Medicaid fills in the gaps: pays Medicare premiums, deductibles, and copays, and covers services Medicare does not (dental, vision, long-term care)
Medicare Savings Programs (MSPs) in 2026
If you have Medicare but do not qualify for full Medicaid, you may still qualify for a Medicare Savings Program. These programs help pay your Medicare costs:
| Program | Income Limit (Individual) | Income Limit (Couple) | What It Pays |
|---|
| Qualified Medicare Beneficiary (QMB) | $1,350/month | $1,824/month | Part A and B premiums, deductibles, and copays |
| Specified Low-Income Medicare Beneficiary (SLMB) | $1,616/month | $2,184/month | Part B premiums only |
| Qualifying Individual (QI) | Slightly above SLMB limit | Slightly above SLMB limit | Part B premiums only |
Asset limits for QMB and SLMB in 2026 are $9,950 for individuals and $14,910 for couples. (Note: Some states have eliminated or raised asset limits -- check with your state Medicaid agency.)
D-SNP Plans for Dual Eligibles
In 2026, CMS is expanding Dual Eligible Special Needs Plans (D-SNPs). These are Medicare Advantage plans designed specifically for dual eligibles, combining Medicare and Medicaid coverage under one plan with:
- A single insurance card
- One care team coordinating both programs
- Lower out-of-pocket costs
- Often extra benefits like transportation, meal delivery, and dental
If you are dual eligible, enrolling in a D-SNP is often more convenient than managing Medicare and Medicaid separately.
How to Apply
Applying for Medicare:
- You can enroll during your Initial Enrollment Period (IEP) -- the 7-month window starting 3 months before the month you turn 65.
- Apply at ssa.gov, call Social Security at 1-800-772-1213, or visit a local Social Security office.
- If you have SSDI, you are enrolled automatically after 24 months of benefits.
Applying for Medicaid:
- Apply through your state's Medicaid agency or through HealthCare.gov (for states using the federal marketplace).
- Gather proof of income, residency, identity, and household composition.
- Eligibility decisions are usually made within 45 days (90 days for disability-based applications).
- Enrollment is year-round -- there is no open enrollment deadline for Medicaid.
Applying for Medicare Savings Programs:
- Contact your state Medicaid agency and specifically ask about Medicare Savings Programs.
- If you already have Medicaid, ask your caseworker if you qualify for a Medicare Savings Program.
- Extra Help (Low Income Subsidy) for Part D prescription drugs can be applied for through Social Security.
Not sure where to start? Check your eligibility now at CoveredUSA -- it takes 2 minutes.
Medicaid vs Medicare: Which One Do You Need?
Here is a quick guide based on your situation:
| Your Situation | Likely Program |
|---|
| Age 65+, any income | Medicare |
| Age 65+, low income | Medicare + Medicaid (dual eligible) |
| Under 65, low income, expansion state | Medicaid |
| Under 65, low income, non-expansion state | May not qualify for Medicaid; check ACA marketplace |
| Under 65, receiving SSDI for 24+ months | Medicare (disability pathway) |
| Any age, ESRD or ALS | Medicare |
| Child or pregnant, low to moderate income | CHIP or Medicaid (higher thresholds) |
| Income 100-400% FPL, not eligible for Medicaid | ACA marketplace with premium tax credits |
Frequently Asked Questions
What is the main difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65 and older and certain people with disabilities, with no income requirement. Medicaid is a state-federal program for low-income individuals and families of any age. Medicare is based on age or disability status; Medicaid is based on income and need.
Can you have both Medicare and Medicaid at the same time?
Yes. If you are 65 or older (or disabled) and have low income, you can qualify for both. This is called dual eligibility. About 12 million Americans are dual eligible as of 2026. When you have both, Medicare pays first and Medicaid covers remaining costs.
Does Medicare cover nursing home care?
Medicare covers only short-term skilled nursing facility care (up to 100 days) following a qualifying hospital stay of at least 3 days. It does not cover custodial long-term care. Medicaid is the primary payer for long-term nursing home care in the United States.
What are the income limits for Medicaid in 2026?
In states that expanded Medicaid under the ACA, the income limit for adults is 138% of the Federal Poverty Level, which equals about $20,782/year for a single person or $43,056/year for a family of four. In non-expansion states, income limits are much lower and vary by category.
How much does Medicare cost per month in 2026?
Most people pay $0 for Medicare Part A (if they worked 40+ quarters). The standard Part B premium is $202.90/month in 2026. Higher-income enrollees pay more. Many dual-eligible individuals have their Part B premium covered by Medicaid through a Medicare Savings Program.
What does Medicaid cover that Medicare does not?
Medicaid covers long-term care (nursing home and home-based), adult dental services, vision, and personal care services in many states. Medicare's coverage of these services is very limited or nonexistent without a supplemental plan.
How do I know if I qualify for Medicare or Medicaid?
Your age, income, household size, disability status, and state all affect which programs you qualify for. The fastest way to find out is to use the free eligibility screener at CoveredUSA -- it checks Medicare, Medicaid, ACA marketplace, and other programs in about 2 minutes.
What is a Medicare Savings Program?
A Medicare Savings Program (MSP) is a Medicaid-funded benefit that helps pay Medicare costs for people with low incomes who do not qualify for full Medicaid. The Qualified Medicare Beneficiary (QMB) program, with a 2026 income limit of $1,350/month for individuals, is the most comprehensive -- it pays Part A and B premiums, deductibles, and copays.
Is Medicare free?
Part A is free for most people who paid Medicare taxes for 10+ years. Part B has a $202.90/month standard premium in 2026. Low-income Medicare beneficiaries may have their premiums paid by a Medicare Savings Program, making their out-of-pocket cost effectively $0.
Check your eligibility now at CoveredUSA -- it takes 2 minutes.
Sources: CMS.gov, Medicare.gov, Medicaid.gov, KFF.org, HHS.gov. Information reflects 2026 program parameters.
