Medicare vs. Medicaid: What Is the Difference?
Last reviewed: September 2026
They sound alike and they are often confused, but they answer different questions. Medicare mostly follows age or disability. Medicaid mostly follows income, and your state decides much of it.
The short answer
Medicare is a federal programme, generally for people 65 and over and for some younger people with disabilities. Medicaid is run jointly by the federal government and each state, generally for people with low income and limited resources. Some people qualify for both.
Who each programme generally serves
Medicare eligibility usually turns on age - 65 - or on having received Social Security disability benefits for a qualifying period, or on certain specific conditions. Income is not the entry test.
Medicaid eligibility usually turns on income, measured against the federal poverty guidelines, and in some categories on resources as well. Age is not the entry test, though it changes which rules apply to you.
Who runs which
Medicare is federal. The rules, the premiums and the coverage are broadly the same wherever you live.
Medicaid is federal and state together. Washington sets the floor and pays a share; your state sets much of the rest, runs the programme and decides your case. This is why two people with identical incomes in different states can get different answers, and why no single national income rule can tell you whether you qualify.
What each covers
Medicare is organised in parts: hospital insurance, medical insurance, and separate prescription drug coverage, with premiums, deductibles and coinsurance attached. The standard Part B premium in 2026 is $202.90 a month, and people above certain income thresholds pay an income-related amount on top.
Medicaid coverage is generally broader in scope and much cheaper at the point of use, and it covers some things Medicare does not - long-term care being the one people most often discover late. What exactly is covered varies by state and by the category you qualify under.
Having both
It is possible to be enrolled in both. People in that position are often called dual eligibles, and Medicaid may then help with Medicare premiums and cost-sharing. That is a real and common situation rather than an edge case, and it is decided by your state Medicaid agency.
Why one income number is not enough
For the adult expansion group, the income threshold is 138% of the federal poverty guideline. That is a real rule, but it is one of several routes in: children, pregnancy, disability and long-term care each have their own rules, and not every state uses every route. Treating any single percentage as the answer is the most common mistake people make about Medicaid.
What our calculator works out
Our Medicare calculator works out whether an income-related surcharge applies to your premiums and which bracket you fall into. The Medicaid calculator checks the income test for the adult expansion group against your household size and state.
What this does not tell you
Neither calculator decides eligibility. Medicare enrolment is handled by the Social Security Administration and CMS; Medicaid eligibility is decided by your state agency.
The Medicaid check covers the income route for the adult expansion group. It will not tell you about eligibility through disability, long-term care, pregnancy or the children's categories, and it cannot account for a state that has not expanded or that applies its own additional rules.
Official sources
- Medicare.gov - Costs
- Centers for Medicare & Medicaid Services - 2026 Part B premiums and deductibles
- Medicaid.gov - Eligibility
- Medicaid.gov - Dual eligible beneficiaries
What you can do next
If you are approaching 65, check what Part B will cost you at your income. If you are below or near the Medicaid threshold, check the income test for your state and household size - and if you are close either way, apply anyway, because the agency decides and the test here is only one of the routes in.
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BenefitCalculators.com is an independent educational site. It is not a government agency, and nothing here is a decision about your benefits.