Medicaid vs. Medicare · What's the Difference?
Plain English. Five calm steps. No pressure.
The names sound alike, but they're very different programs. Medicare is based mainly on age or disability. Medicaid is based on income and resources. Millions of people qualify for both — and having both can lower your costs a great deal.
Free · Private · About a 10-minute read
Your Comparison Path
Read them in order, or jump straight to what you need.
The two programs, compared at a glance.
Including the big one: long-term care.
How Medicare and Medicaid work together.
Savings programs, even if you don't get full Medicaid.
A quick quiz, and where to apply.
Step 1 Side by Side
An Easy Way to Remember
Here's how the two programs compare on the things that matter most.
| Medicare | Medicaid | |
|---|---|---|
| Who it's for | People 65+, and some younger people with disabilities, ALS or kidney failure | People with limited income and resources, of any age |
| Based on income? | No — though higher incomes pay more for Parts B and D | Yes — income and, often, savings and assets |
| Who runs it | The federal government (CMS) | Each state, with federal funding and rules |
| Same everywhere? | Mostly — Original Medicare is the same nationwide | No — benefits, limits and names vary by state |
| What you pay | Premiums, deductibles and coinsurance | Little or nothing for most covered care |
| Long-term nursing home care | Generally not covered | Covered, if you qualify |
| Where to apply | Social Security | Your state Medicaid agency |
Medicaid has many names. Some states call it something else — like Medi-Cal in California. In Florida, you apply through ACCESS Florida; in Texas, through Your Texas Benefits. It's still Medicaid.
Step 2 What Each Covers
Overlap, With Important Differences
| Type of care | Medicare | Medicaid |
|---|---|---|
| Hospital stays | Yes — Part A | Yes |
| Doctor visits & outpatient care | Yes — Part B (you pay 20%) | Yes |
| Prescription drugs | Yes — Part D plans | Through Medicare Part D if you have both |
| Short-term skilled nursing / rehab | Yes, up to 100 days after a hospital stay | Yes |
| Long-term nursing home care | No | Yes, if you qualify |
| Help at home (personal care) | Generally no | Often, through home- and community-based programs |
| Routine dental, vision, hearing | No (some Medicare Advantage plans add it) | Varies by state |
| Non-emergency medical rides | No (some Medicare Advantage plans add it) | Yes |
The long-term care gap: many families are surprised to learn Medicare doesn't pay for a long nursing home stay or ongoing help with daily activities like bathing and dressing. Medicaid is the largest payer of this care. Qualifying usually means meeting strict income and asset limits, and most states look back 5 years at money given away. If this is a concern, talk with an elder law attorney early.
Step 3 Having Both
"Dual Eligible"
If you qualify for both, Medicare pays first and Medicaid pays second — often covering what Medicare leaves behind, like premiums, deductibles and copays. Many people with both pay little or nothing for their care.
Your doctors and hospitals bill Medicare (or your Medicare plan) first, then Medicaid.
Your prescriptions come from a Medicare drug plan, and you automatically get Extra Help — so drug costs are very low.
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for people with both, often coordinating your Medicare and Medicaid benefits.
D-SNPPeople with Medicaid or Extra Help can make certain coverage changes once a month, not just during Open Enrollment. See SEPs →
Know your billing protection: if you're in the Qualified Medicare Beneficiary (QMB) program, providers who accept Medicare are not allowed to bill you for Medicare deductibles, coinsurance or copays. If you get a bill like that, show your QMB card or letter and call 1-800-MEDICARE.
Step 4 Help Paying Costs
Help Even Without Full Medicaid
Even if your income is too high for full Medicaid, you may qualify for help paying your Medicare costs. These programs are run through your state Medicaid office, and many eligible people never apply.
| Program | What it helps pay | Apply through |
|---|---|---|
| QMB — Qualified Medicare Beneficiary | Part A and Part B premiums, deductibles, coinsurance and copays | State Medicaid office |
| SLMB — Specified Low-Income Medicare Beneficiary | Part B premium | State Medicaid office |
| QI — Qualifying Individual | Part B premium (apply each year; first-come, first-served) | State Medicaid office |
| QDWI — Qualified Disabled & Working Individual | Part A premium, for certain working people with disabilities | State Medicaid office |
| Extra Help | Part D premiums, deductibles and copays | Social Security (automatic with Medicaid or a savings program) |
If a savings program pays your Part B premium, that amount stops coming out of your Social Security check — and any Part B late penalty no longer applies.
Income and asset limits are set by federal rules but many states are more generous. Some states, like New York, don't count savings at all for these programs. It's worth applying even if you think you won't qualify.
Step 5 What Fits You
A Quick, Private Check
Answer four quick questions. You'll see which programs are worth looking into. Your answers stay on your screen and aren't saved or sent anywhere.
Answer the questions to see your list.
General information only — not a decision about eligibility. Your state and Social Security decide who qualifies.
Where to apply for Medicaid and savings programs in our states:
Free help applying: your State Health Insurance Assistance Program (SHIP) can help you see what you qualify for and walk you through the forms — at no cost. Apply for Extra Help at ssa.gov or 1-800-772-1213.
Have Medicare and Medicaid, and want to compare plans? Choose your state:
How Medicare starts. Part A guide →
Part B guide →
How Extra Help lowers drug costs. Drug coverage guide →
Including Special Needs Plans. Medicare Advantage guide →
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Common Questions
Medicare is a federal health insurance program mainly for people 65 and older and some younger people with disabilities, regardless of income. Medicaid is a state-run program for people with limited income and resources, of any age.
Yes. People who qualify for both are called "dual eligible." Medicare pays first, and Medicaid helps pay what's left, such as premiums, deductibles and copays.
Medicare covers short-term skilled nursing care after a qualifying hospital stay — up to 100 days per benefit period. It doesn't pay for long-term custodial care. Medicaid can, if you meet your state's income and asset rules.
A state program that helps pay Medicare premiums and, in some cases, deductibles and coinsurance, for people with limited income and resources. You may qualify even if you don't qualify for full Medicaid.
Through your state's Medicaid agency — online, by phone, by mail or in person. Your State Health Insurance Assistance Program (SHIP) can help for free.
Still have a question? Just ask.
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