What Is Medicare?

Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It primarily serves people age 65 and older, along with certain younger individuals who qualify through disability or specific medical conditions.

Medicare eligibility is not generally based on having a low income. However, income, work history, and other circumstances can affect premiums, eligibility for certain benefits, or access to financial assistance.

Who Qualifies for Medicare?

• People age 65 or older who meet applicable citizenship or residency and enrollment requirements.
• Certain people under age 65 who have received Social Security Disability Insurance benefits for the required period.
• Some people with End-Stage Renal Disease who meet Medicare eligibility rules.
• Some people with Amyotrophic Lateral Sclerosis (ALS), who may qualify for Medicare without the usual disability waiting period.

Eligibility can depend on work history, entitlement to Social Security or Railroad Retirement benefits, lawful presence, and other rules. Not everyone automatically receives Medicare when turning 65.

Read the official Medicare eligibility and enrollment guide.

What Are the Different Parts of Medicare?

Medicare has several parts that cover different healthcare services.

Medicare Part A: Hospital Insurance

Part A helps cover eligible inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services. Deductibles, coverage limits, and other requirements may apply.

Medicare Part B: Medical Insurance

Part B helps cover eligible doctor visits, outpatient care, preventive services, medical equipment, and other medically necessary services. Most beneficiaries pay a monthly premium, along with applicable deductibles and coinsurance.

Medicare Part C: Medicare Advantage

Medicare Advantage plans are offered by Medicare-approved private insurers as an alternative way to receive Medicare Part A and Part B benefits. Many plans also include prescription drug coverage, and some offer additional benefits. Costs, provider networks, and plan rules vary.

Medicare Part D: Prescription Drug Coverage

Part D helps cover eligible prescription medications through Medicare-approved drug plans. Coverage and out-of-pocket costs depend on the plan and applicable rules.

Explore the official Medicare coverage parts.

What Is Medicaid?

Medicaid is a joint federal and state health coverage program. It helps eligible people with limited income and resources pay for healthcare. Covered groups can include children, pregnant women, parents, other eligible adults, older adults, and people with disabilities.

Unlike Medicare, Medicaid eligibility rules and benefits can vary significantly by state. Each state operates its own program within federal requirements and determines eligibility based on the applicable category, income methodology, residency, and other conditions.

Who May Qualify for Medicaid?

• Children in eligible households.
• Pregnant women who meet state eligibility requirements.
• Parents and eligible low-income adults.
• People age 65 and older who qualify under applicable Medicaid rules.
• Individuals with disabilities who meet the requirements of an eligible coverage category.
• Other groups covered under federal law and state program options.

Some states have expanded Medicaid to cover more low-income adults. In states that have not adopted expansion, eligibility for adults without dependent children may be more limited. Check the current rules in your state before deciding whether you qualify.

Review official Medicaid eligibility policies.

Medicare vs Medicaid Eligibility: Main Differences

Age Requirements

Medicare is commonly associated with turning 65, although certain younger people can qualify through disability or specific medical conditions. Medicaid does not have one universal age threshold; eligibility categories include children, adults, pregnant women, older adults, and people with disabilities.

Income and Resources

Basic Medicare eligibility at age 65 is generally not determined by low income. Income can, however, affect premiums and eligibility for financial assistance programs. Medicaid commonly uses income tests, and resource limits may apply to certain categories, particularly older adults and people with disabilities.

State Residency

Medicare follows federal eligibility and coverage rules. Medicaid applicants generally must live in the state where they apply and satisfy that state's requirements.

Covered Services

Medicare covers many hospital, medical, and prescription drug services through its different parts. Medicaid may cover additional services depending on the state and eligibility category, including certain long-term care services, personal care, and other benefits.

Out-of-Pocket Costs

Medicare beneficiaries may pay premiums, deductibles, coinsurance, and copayments. Medicaid generally has limited cost-sharing for many eligible beneficiaries, although rules vary by state and coverage category. Medicaid may also help eligible Medicare beneficiaries pay certain Medicare expenses.

Can You Have Medicare and Medicaid at the Same Time?

Yes. A person who qualifies for both programs is often called dual eligible. This commonly includes some older adults and people with disabilities who also meet their state's Medicaid eligibility requirements.

When both programs cover a service, Medicare generally pays first for Medicare-covered services, and Medicaid may pay second according to the coverage and payment rules that apply.

Depending on the level of Medicaid coverage, assistance may include:

• Help paying Medicare Part B premiums.
• Help with certain Medicare deductibles, coinsurance, and copayments.
• Help with Part A premiums for people who have to pay them, when eligible.
• Medicaid coverage for certain services not covered by Medicare.
• Automatic eligibility for Medicare Extra Help with prescription drug costs when the applicable full-benefit Medicaid conditions are met.

Having Medicare does not automatically qualify you for Medicaid. You must meet the requirements for the relevant state program or assistance category.

Learn how Medicare works with Medicaid.

Medicare Savings Programs: Help Paying Medicare Costs

If you have Medicare and limited income and resources, you may qualify for a Medicare Savings Program. These programs are administered by state Medicaid agencies and can help pay certain Medicare costs.

• Qualified Medicare Beneficiary (QMB): May help pay eligible Part A and Part B premiums and Medicare cost-sharing for covered services.
• Specified Low-Income Medicare Beneficiary (SLMB): Helps eligible people pay their Part B premiums.
• Qualifying Individual (QI): Helps eligible people pay Part B premiums, subject to program rules and available funding.
• Qualified Disabled and Working Individuals (QDWI): May help certain eligible working people with disabilities pay Part A premiums.

For 2026, the federal QMB monthly income guideline listed by Medicare is $1,350 for an individual and $1,824 for a married couple, with standard resource limits of $9,950 and $14,910 respectively. State rules, allowable disregards, and higher limits in Alaska and Hawaii can affect eligibility. These figures are not universal Medicaid income limits.

Check the current thresholds and requirements with your state agency before applying.

Check official Medicare Savings Program requirements.

How to Apply for Medicare

Many people become eligible for Medicare around age 65. Some are enrolled automatically, while others must sign up through Social Security.

1. Review your eligibility and enrollment period.
2. Check whether you will be enrolled automatically based on your Social Security benefits.
3. If you need to enroll, use the official Social Security application process.
4. Review your choices for Original Medicare or Medicare Advantage and decide whether you need prescription drug coverage.
5. Check whether you qualify for a Medicare Savings Program or Extra Help with prescription costs.

For many people turning 65, the initial enrollment period begins three months before the month they turn 65 and ends three months after that month. Special enrollment rules may apply if you have qualifying employer coverage or other circumstances.

Apply for Medicare through Social Security.

How to Apply for Medicaid

Medicaid applications are handled through state agencies. The application process depends on your state, household circumstances, and the eligibility category under which you apply.

1. Find the official Medicaid application website for your state.
2. Review the income, residency, household, and other requirements that apply to your situation.
3. Complete the application and provide accurate information about household members and income.
4. Submit any documents requested by the agency.
5. Monitor your application and respond to requests for verification.
6. Review your eligibility notice and any instructions about renewing coverage.

You can also begin through the Health Insurance Marketplace, which may determine whether you qualify for Medicaid or other coverage. Use official government websites and follow your state's instructions.

Find Medicaid and CHIP application information.

Find your state Medicaid agency.

Which Program Is Better for You?

Medicare and Medicaid are designed for different eligibility groups, so one is not automatically better than the other. The appropriate program depends on your age, health circumstances, income, resources, and state rules.

• If you are turning 65: Check your Medicare enrollment options and whether you qualify for financial assistance.
• If your income is limited: Review your state Medicaid program and possible Medicare Savings Program eligibility.
• If you have a qualifying disability: Check Medicare eligibility and your state Medicaid options.
• If you need long-term care: Review the specific services covered by Medicaid in your state and the limitations of Medicare coverage.
• If you may qualify for both: Ask your state Medicaid agency how dual eligibility could help with your healthcare expenses.

Do not cancel existing coverage or delay enrollment based only on a general online guide. Confirm your individual options with the relevant government agency or a qualified benefits counselor.

Frequently Asked Questions: Medicare vs Medicaid

1. What is the main difference between Medicare and Medicaid?

Medicare is a federal health insurance program primarily for people age 65 and older and certain younger people with disabilities or qualifying conditions. Medicaid is a joint federal and state program that provides coverage to eligible people who meet financial and other requirements.

2. Can I qualify for Medicare before age 65?

Yes. Certain people under 65 qualify through disability or specific medical conditions, including qualifying cases of End-Stage Renal Disease or ALS.

3. Does Medicaid have the same income limit in every state?

No. Medicaid eligibility depends on the state, eligibility category, household circumstances, and applicable income-counting rules. Some states cover additional groups under approved program options.

4. Can a person have Medicare and Medicaid together?

Yes. People who meet the requirements of both programs can be dual eligible. Medicaid may help pay certain Medicare premiums and out-of-pocket costs and may cover additional services.

5. Does Medicare cover nursing home care?

Medicare may cover qualifying skilled nursing facility care for a limited period under specific conditions. It generally does not cover long-term custodial care. Medicaid may cover eligible long-term nursing facility services and certain home and community-based services, subject to state rules.

6. Is Medicaid free?

Many eligible Medicaid beneficiaries have low or no costs for covered services, but cost-sharing rules vary by state and eligibility category. Confirm the costs that apply to your coverage.

7. How do I check whether I qualify for both programs?

Check Medicare eligibility through Medicare.gov or Social Security, and contact your state Medicaid agency for a determination under the rules that apply to your household.

8. Does Medicare automatically enroll everyone when they turn 65?

No. Some people are enrolled automatically, while others must apply. Your enrollment situation may depend on whether you already receive Social Security benefits and other circumstances.

9. Where can I apply for Medicare or Medicaid?

For Medicare, visit Medicare.gov or Social Security. For Medicaid, contact your state Medicaid agency or begin through HealthCare.gov.

Official Government Resources

• Medicare.gov: Official Medicare Information
• Medicaid.gov: Official Medicaid Information
• Social Security: Medicare Enrollment
• Medicare and Medicaid Coverage Together
• Medicare Savings Programs
• HealthCare.gov: Medicaid and CHIP

Final Takeaway

The key difference between Medicare and Medicaid is who qualifies and how coverage is administered. Medicare primarily serves older adults and certain younger people with disabilities or qualifying conditions. Medicaid serves eligible people who meet state-specific financial and other requirements.

If you qualify for both, the programs may work together to reduce healthcare costs and cover additional services. Review the official government resources and contact the appropriate agency to confirm your eligibility before making healthcare coverage decisions.