What is the Difference Between Medicare and Medicaid?

What is the Difference Between Medicare and Medicaid?

In short: Medicare is federal health insurance you qualify for by age (65+) or disability, regardless of income. Medicaid is a joint federal-and-state program you qualify for based on limited income and resources. They are separate programs, and if you qualify for both you can have both (called "dual eligibility"), which gives you the most complete coverage.

	Medicare	Medicaid
Who it's for	People 65+, or under 65 with a qualifying disability	People with limited income and resources, any age
You qualify based on	Age or disability, not income	Income and household size
Who runs it	Federal government (CMS)	Federal + your state (rules vary by state)
What it costs	Premiums, deductibles, and copays (the 2026 Part B premium is $202.90/month)	Often $0 to low cost, based on your income
What it covers	Hospital (Part A), medical (Part B), Medicare Advantage (Part C), drugs (Part D)	Doctor and hospital care, plus benefits Medicare skips, like nursing home and personal care
When you enroll	Around your 65th birthday, or when disability coverage begins	Any time you meet your state's income limits

While both programs are health insurance programs run and assisted by the government, there are many differences between the two, including who they aim to assist. These terms are often confused, and many people don’t understand how these programs can help them. Additionally, not many people understand what they qualify for, or how to sign up for or receive the benefits that they do qualify for. Let’s get started unwrapping all of these details between Medicare and Medicaid.

Medicare

Medicare is the federal health insurance program for seniors. Centers for Medicare and Medicaid Services (CMS) is the federal agency that runs Medicare. CMS provides health coverage to millions of people in the United States through their various programs.  Medicare is individual insurance offered to those qualifying based on age, disability, or qualifying medical condition.

Who is eligible for Medicare?

• Most people over age 65 are eligible for Medicare coverage.

• You must also be a U.S. citizen or a legal permanent resident for at least five consecutive years.

• Certain people under age 65 can be eligible for Medicare, if they meet specific requirements.

What does Medicare Cover?

There are 4 main services provided by Medicare, often referred to as parts A-D.

• Medicare Part A is hospital services and Part B is medical care. Parts A and B are almost always added when you initially sign up for Medicare.
• Medicare Part C is usually referred to as Medicare Advantage, and is offered by private insurance companies.
• Part D refers to Prescription Drug Coverage, and can be added on to your Original Medicare, or is often bundled into your Medicare Advantage.

There are also supplemental, Fee-For-Service benefits that you can add on to your Medicare plans, or can have included in certain Medicare Advantage Plans.

What does Medicare Cost?

Costs can vary depending on what you enroll for. Most people don’t pay a premium for Part A, though there are some exceptions. In 2026, the standard Part B premium is $202.90/month per month (higher earners pay more through IRMAA), and it’s typically deducted from your monthly Social Security benefit. For the full picture, see our 2026 Medicare costs breakdown.

Medicare Advantage Plans come with their own premium, but many of these plans offer $0 premiums. Some of these plans can even offer reimbursement for Part B costs.

Aside from Premiums, you also need to factor in deductibles, co-pays and co-insurances, and out-of-pocket costs. These can vary by plan as well, so it’s best to compare plans to find the best fit for you.

Read more about enrolling in Medicare.

Medicaid

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program. This means eligibility requirements and benefits can vary from state to state. The difference between Medicare and Medicaid is as follows:

Who is Eligible for Medicaid?

Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community-based services and children in foster care who are not otherwise eligible. There are also options for states to establish a “medically needy” program for individuals with significant health needs, whose income is too high to otherwise qualify. Find out if you qualify for your state’s Medicaid program.

What does Medicaid Cover?

Federally mandated benefits include inpatient and outpatient medical services such as hospitalization, lab work, X-rays, and doctor visits. People with Medicaid usually don’t pay anything for covered medical expenses but may owe a small co-payment for some items or services.

Medicaid offers benefits that Medicare doesn’t normally cover, like nursing home care and personal care services.

Benefits that vary by state include prescription drugs, physical and occupational therapy, and more.

What does Medicaid Cost?

Some or all of your costs may be covered on Medicaid. Costs are formulated based upon income and eligibility rules in states that offer Medicaid. Those costs can include premiums, deductibles, copays, and coinsurance.

Can You Have Both Medicare And Medicaid?

Yes! You can qualify for both individually. If you are over 65, and you meet your states requirements for Medicaid, you can enroll for both together. Medicare and Medicaid together offer more comprehensive benefits for individuals who are eligible for both than being on just one or the other.

If You Have Medicare And Medicaid, Which Is Primary?

Medicare is first responsible for medical needs, but Medicaid can cover costs that Medicare coverage  does not. When you visit a provider that takes both Medicare and Medicaid, Medicare pays first for the cost of your care. Medicaid pays second, covering copays and other costs not covered.

If you qualify for both Medicare and Medicaid, you’re likely eligible for the Qualified Medicare Beneficiary (QMB) program, one of four Medicare Savings programs. With the QMB program, you’ll get help with Part A and Part B premiums, coinsurance, and deductibles.

If you have further questions, reach out to Medicare Advocates. We’ll ensure you get on the most cost-effective coverage available.