Medicare and Medicaid are government health programs, but they serve different groups and follow different rules.
Medicare is federal health insurance mainly for people age 65 and older and certain younger people with disabilities or qualifying conditions. Medicaid is a joint federal-state program that covers eligible people based on income and other state rules.
Some people qualify for both.
Medicare at a Glance
Medicare is federal health insurance for people age 65 and older, certain younger people with disabilities, and people with specific qualifying conditions.
Eligibility is not generally based on low income, though income can affect premiums and financial help.
The Parts of Medicare
- Part A generally covers inpatient hospital care, qualifying skilled nursing facility care, hospice, and some home health care.
- Part B generally covers outpatient care, clinician services, preventive services, durable medical equipment, and some home health services.
- Part C, Medicare Advantage, provides Part A and Part B benefits through a Medicare-approved private plan.
- Part D helps cover prescription medicines.
Medicaid at a Glance
Medicaid is administered by states under federal requirements and funded jointly by state and federal governments.
It may cover eligible low-income adults, children, pregnant people, older adults, people with disabilities, parents, caregivers, and other groups defined by state rules.
How Eligibility Differs
Medicare eligibility is mainly connected to age, disability, or certain conditions.
Medicaid eligibility may consider household income, household size, age, pregnancy, disability, state residency, immigration status under program rules, and need for long-term services.
Can You Have Both?
Yes. People enrolled in both are often called dually eligible.
Medicare generally pays first for Medicare-covered services. Medicaid may help with premiums, cost sharing, and services Medicare does not normally cover, depending on the state.
Medicare Savings Programs
State Medicaid programs administer Medicare Savings Programs that may help eligible people pay Part A or Part B premiums and certain deductibles, coinsurance, or copayments.
Extra Help
Medicare Extra Help can reduce Part D prescription costs for eligible people with limited income and resources.
How to Apply
Apply for Medicare through Social Security, Medicare.gov, or the Railroad Retirement Board when applicable.
Apply for Medicaid through the state Medicaid agency or state application system.
Free Enrollment Help
State Health Insurance Assistance Programs provide free, unbiased Medicare counseling. Medicaid agencies, Marketplace navigators, community health centers, and aging or disability organizations may also help.
Sources
- Medicare: Parts of Medicare
- Medicare: Medicaid
- Medicaid.gov: Eligibility
- Medicaid.gov: Seniors and Medicare-Medicaid enrollees
- SHIP: Find local Medicare counseling
This article is for general information only and is not insurance, legal, or medical advice.