Medicare vs. Medicaid: What's the Difference?
Last reviewed: June 2026 · Reviewed by Galit Sacajiu MD, MPH
Medicare and Medicaid are both government health insurance programs — but they serve different populations, are funded differently, and cover different services. Understanding which program applies to you (or whether you qualify for both) is essential.
| Medicare | Medicaid | |
|---|---|---|
| Who it's for | People 65+, or under 65 with certain disabilities | Low-income individuals and families of any age |
| Based on | Age or disability status | Income and assets |
| Run by | Federal government (CMS) | Federal + state governments jointly |
| Premiums | Part B: $202.90/mo standard | Usually $0 or very low |
| Deductibles | Yes (Part A, Part B, Part D) | Usually $0 or minimal |
| Dental/Vision | Not in Original Medicare | Often covered (varies by state) |
| Long-term care | Very limited (up to 100 SNF days) | Covers nursing home care |
| Prescription drugs | Part D (separate plan) | Usually included |
Medicare: The Basics
Medicare is a federal health insurance program primarily for people age 65 and older. It is also available to younger people with certain disabilities (after 24 months of Social Security Disability Insurance) and people with End-Stage Renal Disease (ESRD) or ALS.
Eligibility for Medicare is based on age or disability status — not income. You can be a millionaire and still qualify for Medicare at age 65.
Medicare is divided into four parts: Part A (hospital), Part B (medical), Part C (Advantage), and Part D (drugs).
Medicaid: The Basics
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. Unlike Medicare, eligibility is based on income and assets, not age.
Medicaid covers people of all ages — children, pregnant women, adults, elderly people, and people with disabilities. Each state runs its own Medicaid program within federal guidelines, so benefits and eligibility vary by state.
Medicaid is the primary payer for long-term care in the U.S. — nursing home stays that Medicare covers only partially. This makes Medicaid especially important for seniors with limited assets.
Can You Have Both? — Dual Eligibility
Yes. People who qualify for both Medicare and Medicaid are called "dual eligibles" or "Medicare-Medicaid beneficiaries." About 12 million Americans fall into this category.
How dual eligibility works:
- 1. Medicare pays first as the primary payer
- 2. Medicaid pays second, covering Medicare's cost-sharing (premiums, deductibles, copays)
- 3. For dual eligibles, total out-of-pocket costs are often $0
- 4. Special "Dual Eligible Special Needs Plans" (D-SNPs) are available — a type of Medicare Advantage designed for this group
Common Confusion Points
Does Medicare pay for nursing home care? ▼
Medicare Part A covers up to 100 days in a skilled nursing facility after a qualifying hospital stay — but only for skilled care, not custodial (personal) care. Long-term nursing home care is primarily covered by Medicaid.
Is Medicaid the same as Medicare Advantage? ▼
No. Medicare Advantage (Part C) is a type of Medicare plan offered by private insurers. Medicaid is a completely separate program for low-income individuals.
Do I need to apply for both separately? ▼
Yes. Medicare enrollment happens through the Social Security Administration. Medicaid applications go through your state's Medicaid agency. They are separate processes.