Medicare vs. Medicaid: What Is the Difference?

1The difference in one sentence

Medicare follows your age or disability; Medicaid follows your income, and your state decides much of it. Almost everything else about the two programs flows from that split.

Because the tests are so different, qualifying for one tells you little about the other. A retiree with a comfortable pension still gets Medicare at 65 and will not get Medicaid. A 30-year-old with no income may get Medicaid but cannot get Medicare. And a growing number of older people with modest means qualify for both, which is where the two programs become partners rather than alternatives.

2Side by side

Swipe sideways to see the whole table.

The rest of this guide fills in each row, starting with the program most people meet first.

3Medicare: who gets it, and what it costs

Most people qualify at 65 if they are U.S. citizens or have been lawful permanent residents for at least five years. Premium-free Part A, the hospital insurance, requires about ten years of work, by you or your spouse; others can buy it. People under 65 qualify after 24 months of Social Security disability benefits, at once if they have ALS, and with end-stage kidney disease after dialysis or a transplant.

If you already receive Social Security at 65, you are enrolled automatically. Otherwise you sign up during a seven-month window around your 65th birthday, and a late Part B sign-up can bring a penalty that lasts for life; our guide to Medicare sign-up deadlines and penalties has the dates.

Medicare comes in parts. Part A covers hospital stays, skilled nursing after a hospital stay, hospice and some home health care. Part B covers doctors, outpatient care, preventive services and equipment. Part D covers prescriptions. Medicare Advantage bundles them in a private plan, usually with a network; see Original Medicare and Medicare Advantage for that choice.

It is not free. In 2026 the Part B premium is $202.90 a month for most people, higher for individuals with income over $109,000 or couples over $218,000. The Part B deductible is $283, after which you usually pay 20 percent. The Part A hospital deductible is $1,736 for each benefit period. Part D premiums vary, and out-of-pocket spending on covered drugs is capped at $2,100 for the year. Original Medicare also leaves out routine dental care, glasses and hearing aids, and has no yearly ceiling on what you pay, which is why many people add a Medigap policy. The safest time to buy one is the six months starting when you are 65 and enrolled in Part B, when insurers cannot refuse you or charge more for your health. Our guide to what Medicare costs prices a typical year, bill by bill.

For someone on Social Security, the Part B premium is usually deducted from the monthly benefit, so it shows up as a smaller deposit rather than a bill. Estimate your Medicare premium to see where your income puts you.

4Medicaid: several doors, each with its own rules

Medicaid is not one test but several, and states choose some of them.

• Adults under 65 in states that expanded Medicaid qualify with income up to 138 percent of the poverty line, about $22,025 a year for one person and $45,540 for a family of four in 2026, with no asset test.
• Children and pregnant women have higher limits in every state, often with the Children's Health Insurance Program covering children above the Medicaid limit.
• People who are 65 or older, blind or disabled face income limits often tied to SSI, plus a limit on savings.
• People who need nursing home or home care can have higher income but face a close look at their assets.

Where you live matters enormously. Most states have expanded Medicaid to adults; about ten have not. Picture a single 40-year-old earning $20,000 a year. In an expansion state she qualifies. In a state that has not expanded, her income alone would not, though at about 125 percent of the poverty line she could buy Marketplace coverage with a premium tax credit. Since October 1, 2026, federal Medicaid covers fewer immigrants: mainly lawful permanent residents, who generally wait five years, though many states still cover lawfully residing children and pregnant women without that wait. Our guide to Medicaid income limits and who qualifies goes through each group in turn.

One feature rewards acting quickly: Medicaid can pay bills from up to three months before the month you apply if you would have qualified then. That window is shrinking for applications from January 2027, as explained below, so after a hospital stay or a sudden drop in income it is worth applying right away rather than waiting for the bills to arrive. Check the Medicaid income test for your state and household size.

5Where they differ most: long-term care

This is the row in the table that surprises families most often, usually at a hard moment. Medicare pays for skilled nursing care for a limited time after a qualifying hospital stay, up to 100 days with daily coinsurance after day 20. It does not pay for custodial care, the everyday help with bathing, dressing and eating that most long-term nursing home residents need.

Medicaid does, and it is the largest payer of that care in the country. To qualify, a person's assets are tested closely, gifts and transfers made in the previous five years are reviewed, and some income and savings are protected for a spouse who stays at home. After the person's death, states must seek to recover what Medicaid paid for long-term care from the estate, with exceptions. Our guide to who pays for nursing home care walks through how families usually get from private payment to Medicaid.

6When you can have both

People enrolled in both programs are called dual eligibles. Medicare pays first, and Medicaid picks up some or all of what is left: premiums, deductibles, coinsurance, and services Medicare does not cover, such as long-term care.

Far more people qualify for partial help than for full Medicaid. The Medicare Savings Programs pay the Part B premium, and sometimes deductibles and coinsurance, for people with limited income and savings, and anyone in them also qualifies for Extra Help with drug costs. If you are on Medicare and money is tight, this is the help most worth checking, because its limits are higher than full Medicaid's and many eligible people never apply.

Full dual eligibles can also join a Dual Eligible Special Needs Plan, a kind of Medicare Advantage plan built to coordinate the two programs, though staying in Original Medicare with Medicaid behind it remains an option.

7Moments when the two programs meet

Turning 65 while on Medicaid

You will generally be required to enroll in Medicare, which then pays first. If you still qualify for Medicaid, it becomes your secondary coverage, and your state may pay your Medicare premiums.

Moving from Marketplace coverage to Medicare

A Marketplace premium tax credit stops once you can get premium-free Part A. Sign up for Medicare on time and end the Marketplace plan when Medicare starts, or you may pay the full Marketplace premium.

Working past 65

If you or your spouse still work for an employer with group health coverage, you may be able to delay Part B without a penalty and sign up later in a special enrollment period. Check how the employer plan works with Medicare before you decide.

8Signing up for each

The two programs are applied for in different places, and the experience is different too.

Medicare runs through Social Security. If you already receive Social Security benefits, you are enrolled in Parts A and B automatically and your card arrives in the mail a few months before your 65th birthday; you can decline Part B if you have qualifying coverage from current work. Everyone else applies online at ssa.gov, by phone or at a local office during the enrollment window. Drug coverage and Medicare Advantage plans are chosen separately, through Medicare's plan finder.

Medicaid runs through your state. You can apply through the state Medicaid agency or through HealthCare.gov, which passes your application to the state. Expect to show proof of income, identity, citizenship or immigration status and where you live, and, for the older, blind and disabled groups or long-term care, statements for bank accounts and other assets. Federal rules give states up to 45 days to decide most applications, and up to 90 days when the decision depends on a disability.

If you might qualify for both, apply for both. Medicare enrollment does not start a Medicaid application, and Medicaid does not enroll you in Medicare, though a state will usually require you to sign up for Medicare once you are eligible.

9What the 2025 law changes for Medicaid

The 2025 federal budget law adds work requirements for many adults in the expansion group, generally starting by January 2027: 80 hours a month of work, training, volunteering or school, with exemptions for parents of young children, people with disabilities and others. Expansion adults will also have to renew eligibility more often. And for applications from January 2027, the period of retroactive coverage shrinks from three months to one month for expansion adults and two months for most others. Our guide to SNAP and Medicaid work requirements explains who is affected. Medicare eligibility does not change.