Medicare is for seniors (65+); Medicaid is for low-income individuals. Medicare is federal and age-based; Medicaid is state-run and income-based. Some people qualify for both.
Medicare vs. Medicaid Quick Comparison
| Feature | Medicare | Medicaid |
|---|---|---|
| Eligibility basis | Age (65+) or disability | Income level |
| Administration | Federal (CMS) | State governments |
| Premium | Yes ($174.70+/month) | Usually $0 |
| Income limits | None | Yes (varies by state) |
| Asset limits | None | Yes (varies by state) |
| Coverage | Standardized nationwide | Varies by state |
| Enrollment | Automatic at 65 | Apply through state |
Who Qualifies for Medicare?
Medicare eligibility is based on age and work history:
| Category | Eligibility |
|---|---|
| 65+ with 40 work credits | Automatic enrollment |
| Under 65 with disability | After 24 months on SSDI |
| Any age with ESRD | End-stage renal disease |
| Any age with ALS | Lou Gehrig’s disease |
Work credits: Approximately 10 years of work (paying Medicare taxes).
Who Qualifies for Medicaid?
Medicaid eligibility varies by state but generally includes:
| Category | Federal Minimum |
|---|---|
| Adults (expansion states) | Up to 138% FPL (~$20,800 single) |
| Pregnant women | Up to 138-200% FPL |
| Children | Up to 200-300% FPL |
| Elderly/disabled | SSI recipients |
| Medically needy | High medical expenses |
FPL = Federal Poverty Level. Many states set higher limits.
Medicare Parts Explained
| Part | Coverage | Premium (2026) |
|---|---|---|
| Part A | Hospital, skilled nursing | $0 (if worked 10+ years) |
| Part B | Doctors, outpatient care | $174.70/month |
| Part C | Medicare Advantage (private) | Varies ($0+) |
| Part D | Prescription drugs | Varies (~$35/month) |
What Medicare Covers
| Part A (Hospital) | Part B (Medical) |
|---|---|
| Inpatient hospital | Doctor visits |
| Skilled nursing (limited) | Outpatient surgery |
| Hospice care | Lab tests |
| Home health care | Preventive services |
What Medicare Does NOT Cover
- Long-term care
- Most dental
- Most vision
- Hearing aids
- Overseas care
Medicaid Coverage
Medicaid coverage varies by state but typically includes:
| Service | Usually Covered |
|---|---|
| Doctor visits | ✓ |
| Hospital stays | ✓ |
| Prescription drugs | ✓ |
| Lab tests | ✓ |
| Nursing home care | ✓ |
| Long-term care | ✓ |
| Dental | Varies |
| Vision | Varies |
| Mental health | ✓ |
Medicaid often covers more than Medicare (including long-term care).
Cost Comparison
Medicare Costs (2026)
| Cost Type | Typical Amount |
|---|---|
| Part A premium | $0 (most people) |
| Part B premium | $174.70/month |
| Part D premium | ~$35/month |
| Part A deductible | $1,676/hospital stay |
| Part B deductible | $257/year |
| Part B coinsurance | 20% of costs |
Many people buy Medigap to cover gaps.
Medicaid Costs (2026)
| Cost Type | Typical Amount |
|---|---|
| Premium | $0 |
| Copays | $0-$4 typically |
| Deductible | Usually $0 |
| Out-of-pocket max | Minimal |
Medicaid has very low cost-sharing for enrollees.
Medicare Enrollment Periods
| Period | When | Purpose |
|---|---|---|
| Initial Enrollment | 7-month window around 65th birthday | First sign-up |
| General Enrollment | Jan 1 - Mar 31 | Missed initial period |
| Open Enrollment | Oct 15 - Dec 7 | Change plans |
| Special Enrollment | After qualifying event | Job loss, move, etc. |
Late enrollment = permanent premium penalties.
Medicaid Application
How to apply for Medicaid:
- Apply through your state Medicaid agency
- Or apply through Healthcare.gov marketplace
- Provide income/asset documentation
- Decision typically within 45 days
- Coverage may be retroactive 3 months
Dual Eligibility: Medicare + Medicaid
If you qualify for both:
| Benefit | What Happens |
|---|---|
| Primary insurance | Medicare pays first |
| Cost-sharing | Medicaid covers premiums, copays |
| Extra coverage | Medicaid fills Medicare gaps |
| Long-term care | Medicaid covers (Medicare doesn’t) |
| Programs | QMB, SLMB, QI help with costs |
About 12 million Americans are “dual eligible.”
Medicare Savings Programs
If you have Medicare but limited income:
| Program | Income Limit | What It Covers |
|---|---|---|
| QMB | 100% FPL | Part B premium + deductibles |
| SLMB | 120% FPL | Part B premium |
| QI | 135% FPL | Part B premium |
| LIS (Extra Help) | 150% FPL | Part D costs |
Long-Term Care Coverage
| Type of Care | Medicare | Medicaid |
|---|---|---|
| Skilled nursing (short-term) | 100 days max | Yes |
| Nursing home (long-term) | No | Yes |
| Home health care | Limited | Yes |
| Assisted living | No | Some states |
Key difference: Medicaid covers long-term nursing home care; Medicare does not.
Medicaid Expansion by State
As of 2026, 40 states have expanded Medicaid:
| Status | States |
|---|---|
| Expanded | CA, NY, FL, TX, IL, PA, OH, GA*, NC*, and 31 others |
| Not expanded | WI, WY, KS, and ~7 others |
*Recent expansions. Check your state’s current status.
In non-expansion states, childless adults often can’t qualify regardless of income.
Medicare vs. Medicaid for Seniors
| Scenario | Best Option |
|---|---|
| 65+, middle/high income | Medicare only |
| 65+, low income | Both (dual eligible) |
| 65+, need nursing home | Need Medicaid (spend down) |
| 65+, under 138% FPL | Dual eligible |
Many seniors must “spend down” assets to qualify for Medicaid long-term care.
Common Confusion Points
| Misconception | Reality |
|---|---|
| Medicare is free | Part B costs $175+/month |
| Medicaid is only for the unemployed | Working low-income qualify |
| Medicare covers nursing homes | Only 100 days post-hospitalization |
| Can’t have both | Dual eligibility is common |
| Medicaid is the same everywhere | Benefits vary by state |
Bottom Line
| Program | Who It’s For | Key Feature |
|---|---|---|
| Medicare | 65+ or disabled | Age-based, federal |
| Medicaid | Low-income | Income-based, state-run |
| Both | Low-income seniors | Maximum coverage |
If you’re 65+ and low-income: Apply for both. Medicaid can cover Medicare premiums and copays, plus long-term care that Medicare doesn’t cover.
If you’re under 65 and low-income: Apply for Medicaid through your state or Healthcare.gov.