Medicare and Medicaid are both government health programs, but they're very different. Here's a clear breakdown of who qualifies, what's covered, and how they work together.
Medicaid vs Medicare: The Key Differences
Medicare and Medicaid are often confused — they sound similar, both start with "Medi," and both are government health programs. But they serve very different populations and work in very different ways.
The One-Line Summary
Medicare is for people 65+ and younger people with disabilities.
Medicaid is for people with low incomes, at any age.
Who Qualifies?
Medicare eligibility:
- Adults 65 and older who have worked and paid Medicare taxes
- Younger adults with certain disabilities (after receiving Social Security Disability for 24 months)
- People with End-Stage Renal Disease or ALS
Medicaid eligibility:
- Low-income children and families
- Pregnant women with limited income
- Low-income adults (in expansion states)
- Elderly and disabled individuals with limited income
- Eligibility is based on income, not age
Who Runs the Program?
Medicare is a federal program run entirely by the federal government through the Centers for Medicare & Medicaid Services (CMS).
Medicaid is a joint federal-state program. The federal government sets minimum standards and pays a share of costs, but each state administers its own program. This is why Medicaid rules, benefits, and income limits vary by state.
What Does Each Cover?
Medicare covers:
- Part A: Hospital insurance (inpatient care, skilled nursing, hospice)
- Part B: Medical insurance (doctor visits, outpatient care, preventive services)
- Part C: Medicare Advantage (private plans combining A and B)
- Part D: Prescription drug coverage
Medicaid covers:
- Doctor visits and hospital care
- Prescription drugs
- Mental health and substance use services
- Long-term care (nursing homes, home health)
- Dental and vision in most states
- Transportation to medical appointments
What Does Each Cost?
Medicare costs:
- Part A: Free for most (if you worked 40+ quarters); otherwise up to $505/month
- Part B: $174.70/month premium (2025 standard)
- Deductibles and copays apply
- No cap on out-of-pocket costs in traditional Medicare
Medicaid costs:
- Generally free or very low cost
- Small copays in some states (usually $1–$4 per service)
- No monthly premiums for most beneficiaries
What About Dual Eligibility?
Some people qualify for both Medicare and Medicaid — these individuals are called "dual eligibles" or "dual-eligible beneficiaries." This often happens with low-income seniors or people with disabilities.
For dual eligibles, Medicaid often helps pay for Medicare premiums, deductibles, and copays — significantly reducing out-of-pocket costs. This is called a Medicare Savings Program.
Which Program Should You Apply For?
- If you're 65 or older → Apply for Medicare (you may also qualify for Medicaid)
- If you're under 65 with low income → Apply for Medicaid
- If you're under 65 with a disability → You may qualify for Medicare after 24 months on disability; apply for Medicaid in the meantime
- If you're low-income and 65+ → Apply for both
The Bottom Line
Medicare and Medicaid are complementary programs that together provide coverage for over 130 million Americans. If you're not sure which applies to you, our free eligibility check can help you figure out your options.