Medicaid vs. Medicare — Key Differences

Medicaid is an income-based program for low-income individuals and families, administered by states with federal matching funds. Medicare is a federal health insurance program based on age (65+) or disability status, not income.

Healthcare

Medicaid

Free or low-cost health coverage for low-income individuals and families.

View program →
Seniors

Medicare

Federal health insurance for adults 65+ and some younger disabled individuals.

View program →
Attribute
Medicaid
Medicare
Primary eligibility basis
Income (and sometimes other factors)
Age 65+ or qualifying disability
Income requirement
Yes — generally up to 138% FPL in expansion states
No income requirement
Age requirement
No age requirement for adults in expansion states
65+, or under 65 with qualifying disability or ESRD
Work history required
No
Yes for premium-free Part A (40 credits)
Monthly premiums
None or very low
$0 Part A for most; ~$185/mo Part B (2025)
Long-term care coverage
Yes — nursing home and home care
Very limited — only skilled care up to 100 days
Dental and vision
Covered in many states
Not covered in Original Medicare
Prescription drugs
Covered
Covered via separate Part D plan
Who administers
State agencies with federal funding
Federal government (CMS)
Open enrollment period
Year-round — no enrollment period
Annual enrollment period Oct 15 – Dec 7

Can you receive both? Yes.

Approximately 12 million Americans are "dual eligible" — covered by both Medicaid and Medicare simultaneously. Medicare is the primary payer; Medicaid covers premiums, copays, and services Medicare does not include (dental, vision, long-term care). Being dual eligible typically means little or no out-of-pocket cost.

Which should you apply for?

You do not have to choose between them — they serve different purposes and different populations. If you are under 65 and have low income, apply for Medicaid. If you are 65 or older, enroll in Medicare. If you are both low-income and 65+, apply for both and check whether you qualify for a Medicare Savings Program to help with Medicare costs.

Frequently Asked Questions

Does Medicaid cover everything Medicare does?

Medicaid covers more services in many states, including dental, vision, non-emergency transportation, and long-term care that Medicare does not cover. However, Medicaid provider networks can be more limited than Medicare, and not all doctors accept Medicaid. The specific services covered vary by state.

Will I lose Medicaid when I go on Medicare?

Not necessarily. If you are dual eligible — qualifying for both — you keep both coverages. Medicaid acts as a secondary payer filling gaps in Medicare coverage. If your income is above the Medicaid limit but below Medicare Savings Program limits, you may still get help paying Medicare premiums and cost-sharing.

Can I apply for Medicaid if I already have Medicare?

Yes. If your income and resources are low enough, you can apply for Medicaid even while on Medicare. Apply through your state Medicaid agency — not through healthcare.gov. If approved, the dual coverage dramatically reduces your out-of-pocket costs.