Difference Between Medicaid And Medicare
According to the U.S. Centers for Medicare & Medicaid Services (CMS), over 65 million people were enrolled in Medicare in 2023, while over 87 million individuals were covered under Medicaid by the end of the same year.
Both are government-run programs aimed at supporting healthcare access—but they’re not the same. So, what’s the difference between Medicaid and Medicare?
What Is Medicare?
Medicare is a federal health insurance program designed mainly for:
- People aged 65 and older
- Individuals under 65 with specific disabilities
- People with End-Stage Renal Disease (permanent kidney failure)
➤ Key Medicare Facts:
- Funded by the federal government
- Managed by the Centers for Medicare & Medicaid Services (CMS)
- Enrollment handled at the national level (Social Security Administration)
Parts of Medicare:
Part | Name | What It Covers |
---|---|---|
Part A | Hospital Insurance | Inpatient care, hospital stays, nursing facilities |
Part B | Medical Insurance | Doctor visits, outpatient care, preventive services |
Part C | Medicare Advantage | Combines A & B; offered by private insurers |
Part D | Prescription Drug Coverage | Helps cover cost of prescription meds |
What Is Medicaid?
Medicaid is a joint federal and state program that helps with medical costs for low-income individuals and families.

➤ Key Medicaid Facts:
- Eligibility and benefits vary state by state
- It covers more services than Medicare in many states (especially long-term care)
- Funded by both federal and state governments
- States must meet federal guidelines but can tailor coverage
Who Does Medicaid Serve?
- Low-income adults
- Children (through CHIP in many cases)
- Pregnant women
- Elderly individuals with low income
- People with disabilities
10 Key Differences Between Medicare and Medicaid
Let’s break this down into plain English:
Feature | Medicare | Medicaid |
---|---|---|
Who Runs It | Federal Government | Federal + State |
Eligibility | Based on age/disability | Based on income and need |
Cost to You | Monthly premiums, copays, deductibles | Low or no cost depending on income |
Covers Children? | No | Yes |
Covers Long-Term Care? | Very limited | Yes, including nursing home care |
Prescription Drugs? | Part D (optional) | Often included |
Choice of Doctors? | Any that accept Medicare | Often limited to Medicaid providers |
Enrollment | Through Social Security or Medicare.gov | Through your state’s Medicaid office |
Dental and Vision? | Limited coverage | Often included for children and optional for adults |
Dual Eligibility? | N/A | Yes, you can get both Medicare and Medicaid |
More Opportunities: How to Get Senior Food Allowance?
Eligibility Requirements
Medicare Eligibility in 2025:
- 65 years or older (automatic enrollment in many cases)
- OR under 65 and receiving SSDI (Social Security Disability Insurance) for at least 24 months
- OR diagnosed with ALS or ESRD
Medicaid Eligibility in 2025:
Each state sets its own income limits. But as of 2025, most states follow these general rules:
- Income must fall below 138% of the Federal Poverty Level (FPL)
- For a single adult: Around $20,783/year
- For a family of four: About $43,056/year
- Assets and resources may be considered for elderly or disabled applicants
Check your state requirements here: https://www.healthcare.gov/medicaid-chip/eligibility
Cost Comparison: Medicaid vs. Medicare
Medicare Costs:
- Part A: Usually free (if you worked 10+ years)
- Part B: $174.70/month (standard premium in 2024)
- Part D: Varies based on plan
- Deductibles: $1,632 for Part A; $240/year for Part B
- Copayments: $0–20% for most services
Medicaid Costs:
- Usually free or very low cost
- Some states charge small copayments, like $3–$10 per visit
- No large deductibles or premiums for most enrollees
What’s Covered?
Medicare Covers:
- Hospital stays
- Doctor visits
- Lab tests
- Preventive services (vaccines, screenings)
- Home health care
- Short-term rehab
🔻 Does NOT usually cover:
- Long-term care
- Most dental, vision, or hearing
- Custodial care
Medicaid Covers:
- Everything Medicare covers plus:
- Long-term care (nursing homes)
- Dental and vision (especially for children)
- Mental health and substance abuse treatment
- Transportation to medical appointments
- In-home support for disabled and elderly
Can You Have Both Medicaid and Medicare? (Dual Eligibility)
Yes, over 12 million Americans are dually eligible.
If you qualify for both programs:
- Medicare pays first
- Medicaid covers the leftover costs (copays, deductibles, premiums)
- You may qualify for a Medicare Savings Program (MSP) or Extra Help with prescriptions
This combo provides nearly full coverage with little to no out-of-pocket costs.
Real-Life Scenarios
Scenario 1: Alice, 67, retired teacher
- Gets Medicare automatically
- Pays $174.70/month for Part B
- Chooses Medicare Advantage to bundle dental and vision
Scenario 2: Mark, 45, unemployed and low-income
- Doesn’t qualify for Medicare (not 65)
- Applies for Medicaid through his state
- Gets free care, including prescriptions and mental health services
Scenario 3: Sarah, 70, disabled and low-income
- Has Medicare based on age
- Applies for Medicaid due to low income
- Gets help paying premiums and covers long-term care
Final Thought
Both Medicare and Medicaid play critical roles in the U.S. healthcare system. But they serve different people, have different rules, and offer different types of coverage.
Here’s a recap:
- Medicare = Age/Disability-Based, Federal Program
- Medicaid = Income-Based, Joint Federal-State Program
- You can qualify for both and receive broader benefits
So whether you’re approaching retirement, helping a family member, or navigating your own healthcare journey—it’s crucial to understand these two programs inside and out.
FAQs
Can I lose Medicaid or Medicare?
Yes. If your income increases or your disability status changes, you may lose Medicaid. Medicare typically continues unless you cancel it.
Does Medicaid cover all the same things in every state?
No. States have flexibility. While they must meet federal minimums, many choose to expand services, especially for dental or mental health.
Is Medicare free?
Not entirely. While Part A is often free, Part B, D, and Medicare Advantage usually have monthly premiums and other costs.
Do I have to sign up for Medicare when I turn 65?
Yes, unless you’re already receiving Social Security. You should enroll during the 7-month Initial Enrollment Period to avoid penalties.