Medicare and Medicaid are two completely separate government health programs that are often confused because their names sound so similar. Medicare is a federal health insurance program primarily for people 65 and older, regardless of income. Medicaid is a joint federal-state program that provides coverage to people with low income, at any age. Understanding which program applies to you, and whether you might qualify for both, can make a big difference in your healthcare costs and coverage options.
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The Core Difference: Who Each Program Serves
Medicare is an age-based (and disability-based) program. You qualify by earning it through work history and reaching age 65, or by having a qualifying disability. Income does not affect Medicare eligibility.
Medicaid is an income-based program. You qualify by having low income relative to household size. Age can matter for certain Medicaid categories, but the primary driver is financial need.
This single distinction explains most of the confusion. Two neighbors who are both 66 years old can have very different coverage situations: one might be on Medicare alone, another might be on both Medicare and Medicaid if their income is low enough.
Quick Comparison Table
| Feature | Medicare | Medicaid |
|---|
| Who administers it | Federal government | Federal and state governments jointly |
| Who qualifies | Age 65+ or qualifying disability | Low-income individuals and families |
| Income requirement | None | Yes, varies by state |
| Premiums | Part B: $202.90/month in 2026 | Usually $0 or very low |
| Out-of-pocket costs | Deductibles, copays, coinsurance | Capped at 5% of household income |
| Varies by state | No (Parts A and B are uniform) | Yes, significantly |
| Long-term care coverage | Limited | Yes (primary payer for nursing homes) |
| Dental and vision | Not typically covered | Covered for children; varies for adults |
Medicare: Who Qualifies and What It Covers
Medicare has three main eligibility pathways.
Age 65 or older: Anyone who is 65 or older and is a U.S. citizen or has been a legal permanent resident for at least five years is eligible. You also need 40 quarters (10 years) of Medicare-covered work to get premium-free Part A. If you do not meet that work requirement, you can still buy into Part A.
Disability under 65: If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability benefits, you become eligible for Medicare after 24 months of receiving those benefits. Coverage begins in your 25th month.
End-Stage Renal Disease (ESRD) or ALS: People with kidney failure requiring dialysis or a transplant, and people diagnosed with ALS (Lou Gehrig's disease), qualify for Medicare at any age.
Medicare Parts Explained
Medicare is divided into four parts:
- Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Premium-free for most people with 10+ years of work history.
- Part B covers outpatient care, doctor visits, preventive services, and medical equipment. The standard monthly premium in 2026 is $202.90, with an annual deductible of $283.
- Part C (Medicare Advantage) is an all-in-one alternative to Original Medicare sold by private insurers. Often includes dental, vision, and drug coverage.
- Part D covers prescription drugs. Sold by private insurers with varying costs and formularies.
Medicare 2026 Costs
| Medicare Component | 2026 Cost |
|---|
| Part A premium (most people) | $0 (premium-free) |
| Part A premium (30-39 work quarters) | $311/month |
| Part A premium (under 30 work quarters) | $565/month |
| Part B standard premium | $202.90/month |
| Part B annual deductible | $283 |
| Part A hospital deductible (per benefit period) | $1,676 |
Higher-income beneficiaries pay more for Part B through Income-Related Monthly Adjustment Amounts (IRMAA). If your income is above $106,000 (individual) or $212,000 (married filing jointly), your Part B premium will be higher.
For more on Medicare eligibility, see our Medicare eligibility guide.
Medicaid: Who Qualifies and What It Covers
Medicaid eligibility is determined by income, household size, state of residence, and category of eligibility (parent, pregnant woman, child, elderly, disabled, or expansion adult).
Income Limits for Medicaid in 2026
In states that expanded Medicaid under the Affordable Care Act, adults under 65 can qualify with income up to 138% of the Federal Poverty Level (FPL). That translates to the following 2026 income thresholds:
| Household Size | 138% FPL (Monthly) | 138% FPL (Annual) |
|---|
| 1 person | $1,835 | $22,018 |
| 2 people | $2,482 | $29,786 |
| 3 people | $3,130 | $37,554 |
| 4 people | $3,778 | $45,322 |
| 5 people | $4,425 | $53,090 |
Non-expansion states have more restrictive income limits, and many cover only children, pregnant women, and people with disabilities. Adults without children are often excluded entirely in those states.
For elderly and disabled Medicaid applicants, most states set the income limit at 100% of FPL or use a separate income standard tied to Supplemental Security Income (SSI) rates.
What Medicaid Covers
Medicaid covers a broad range of services, including:
- Doctor visits and outpatient care
- Hospital stays (inpatient and outpatient)
- Preventive services and screenings
- Mental health and substance use treatment
- Prescription drugs
- Pregnancy and maternity care
- Long-term care in nursing homes (this is a major benefit Medicare does not fully cover)
- Personal care services at home
- Dental and vision for children (adult dental varies by state)
One of Medicaid's most important distinctions from Medicare is that it pays for long-term nursing home care. Medicare only covers skilled nursing facility stays for up to 100 days under specific conditions. After that, Medicaid steps in as the primary payer for those who qualify.
Side-by-Side: What Each Program Covers
| Service | Medicare | Medicaid |
|---|
| Hospital stays | Yes (Part A) | Yes |
| Doctor visits | Yes (Part B) | Yes |
| Preventive care | Yes (Part B) | Yes |
| Prescription drugs | Yes (Part D, separate) | Yes (included) |
| Dental (adult) | No | Varies by state |
| Vision (adult) | No | Varies by state |
| Long-term nursing home care | Limited (up to 100 days) | Yes (major benefit) |
| Mental health care | Yes (Part B) | Yes |
| Pregnancy and delivery | No | Yes |
| Home health services | Limited | Yes, broader coverage |
Can You Have Both Medicare and Medicaid?
Yes. People who qualify for both programs are called "dual eligibles" or "dually eligible." In 2026, roughly 12 million Americans are enrolled in both programs.
Dual eligibility works like this: Medicare pays first as the primary insurer. Medicaid pays second and can cover many of the costs Medicare does not, including premiums, deductibles, copays, and services Medicare excludes entirely.
To qualify for both, you generally need to:
- Be eligible for Medicare (age 65+, or disability)
- Meet your state's Medicaid income and asset limits
There are also Medicare Savings Programs specifically designed for people who qualify for Medicare but have limited income. These programs help pay for Part B premiums, deductibles, and copays, even if you do not fully qualify for Medicaid.
How to Apply for Each Program
Applying for Medicare
- Automatic enrollment: If you already receive Social Security benefits when you turn 65, you are automatically enrolled in Medicare Parts A and B. Your card arrives about three months before your 65th birthday.
- Manual enrollment: If you are not receiving Social Security at 65, you need to actively sign up during your Initial Enrollment Period (IEP), which runs from three months before to three months after your 65th birthday.
- Apply online: Visit SSA.gov or call Social Security at 1-800-772-1213.
- Disability pathway: If enrolling based on disability, SSDI enrollment triggers automatic Medicare after 24 months.
Missing your Initial Enrollment Period can result in a permanent late enrollment penalty on your Part B premium, so timing matters.
Applying for Medicaid
- Check your state's income limits: Medicaid rules vary significantly by state. Use CoveredUSA's screener to see if you likely qualify before applying.
- Apply through your state: Go to your state's Medicaid agency website or apply through Healthcare.gov (for ACA expansion Medicaid).
- Gather documents: You will need proof of identity, residency, income (pay stubs, tax returns), and household size.
- No enrollment period: Unlike Medicare or ACA marketplace plans, Medicaid has no annual open enrollment window. You can apply any time of year and coverage can start the month you apply or the month after.
For income limits by state, see our Medicaid income limits reference page.
Common Situations: Which Program Applies?
I am 67 years old with moderate income.
You are eligible for Medicare. At 67, you qualify for Parts A and B. You would need to check your state's Medicaid income limits to see if you also qualify for Medicaid or a Medicare Savings Program.
I am 35 years old with a low income and no job.
You would look at Medicaid. If your state expanded Medicaid, you may qualify at 138% FPL or below. Medicare does not apply unless you have a qualifying disability.
I am 40 years old and just got approved for SSDI.
Medicare will kick in after 24 months of receiving SSDI benefits. In the meantime, you may qualify for Medicaid based on your income.
I am 70 years old and my income is very low.
You likely qualify for both Medicare and Medicaid (dual eligible status). Medicaid can help cover your Medicare premiums and out-of-pocket costs.
I am pregnant with low income.
Medicaid covers pregnancy at higher income thresholds than regular adult Medicaid in most states, often up to 200% FPL or higher. Apply through your state Medicaid office immediately.
Frequently Asked Questions
What is the main difference between Medicare and Medicaid?
Medicare is health insurance for people 65 and older (and some younger people with disabilities), funded federally and based on work history. Medicaid is health coverage for people with low income at any age, funded jointly by the federal government and states. Medicare eligibility does not depend on income. Medicaid eligibility does not depend on age (with some exceptions).
Can I have both Medicare and Medicaid at the same time?
Yes. This is called dual eligibility and affects about 12 million Americans. Medicare pays first as the primary insurer. Medicaid covers remaining costs including premiums, copays, and services Medicare does not cover. To qualify for both, you must meet Medicare eligibility requirements and your state's Medicaid income limits.
Does Medicaid cover nursing home care that Medicare does not?
Yes. This is one of the most important practical differences. Medicare covers skilled nursing facility stays for up to 100 days after a qualifying hospital stay, under very specific conditions. After that coverage ends, Medicaid becomes the primary payer for long-term nursing home care for those who qualify financially.
What does Medicare cost in 2026?
Most people pay $0 for Medicare Part A if they have 10+ years of work history. Medicare Part B has a standard monthly premium of $202.90 in 2026, with a $283 annual deductible. Higher-income enrollees pay more. Part D drug plan costs vary by plan.
What does Medicaid cost?
Medicaid is designed to be free or nearly free for enrollees. Most states charge no monthly premium. Copays are minimal. Total out-of-pocket costs are capped at 5% of household income per year.
Does Medicare cover dental and vision?
Original Medicare (Parts A and B) does not cover routine dental or vision care for adults. Some Medicare Advantage (Part C) plans include dental and vision benefits. Medicaid covers dental and vision for children in all states. Adult dental coverage through Medicaid varies by state.
How do I know which program I qualify for?
Use the CoveredUSA screener at coveredusa.org/screener. Answer a few basic questions about your age, household size, and income, and you will see which programs you likely qualify for, including Medicare, Medicaid, dual eligibility options, and Medicare Savings Programs.
