They sound alike, they are both government health insurance programs, and they were signed into law on the same day in 1965 — so it is no surprise that people confuse them constantly. But Medicaid vs Medicare is not a minor distinction. These are fundamentally different programs that serve different populations, are funded differently, and provide different levels of coverage. Medicare is primarily for Americans 65 and older (plus certain younger people with disabilities), while Medicaid serves low-income individuals and families regardless of age. Some people qualify for both simultaneously. Understanding which program applies to you — or to a family member — affects everything from which doctors you can see to how much you pay out of pocket. Here is a clear, side-by-side comparison to help you sort it out. For a broader overview of health insurance policy, see our healthcare policy guide.
What Is Medicare?
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It primarily covers Americans aged 65 and older, though younger adults with certain disabilities or end-stage renal disease (ESRD) also qualify. In 2024, Medicare covered approximately 67 million people.
Medicare has four parts. Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people pay no premium for Part A if they or a spouse paid Medicare taxes for at least 10 years. Part B (Medical Insurance) covers outpatient care, doctor visits, preventive services, durable medical equipment, and some home health services. The standard Part B premium is $185 per month in 2025, with higher-income beneficiaries paying more through income-related monthly adjustment amounts (IRMAA).
Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurers. These plans bundle Parts A and B, often include Part D drug coverage, and may offer additional benefits like dental, vision, and hearing. Part D (Prescription Drug Coverage) covers outpatient prescription medications through private plans. Premiums vary by plan. Medicare is funded primarily through payroll taxes (Part A), beneficiary premiums, and general federal revenue.
What Is Medicaid?
Medicaid is a joint federal-state program that provides health coverage to low-income individuals and families. Unlike Medicare, Medicaid is means-tested — eligibility depends primarily on income, household size, and in some cases, assets. Each state runs its own Medicaid program within federal guidelines, which means coverage, eligibility thresholds, and provider availability vary significantly by state.
In states that expanded Medicaid under the ACA, adults with incomes up to 138% of the federal poverty level ($20,783 for an individual in 2025) qualify for coverage. Forty states plus DC have adopted Medicaid expansion as of 2025, according to KFF. In the 10 states that have not expanded, Medicaid eligibility for adults is far more restrictive — often limited to pregnant women, parents with very low incomes, and people with disabilities.
Medicaid covers children through the Children’s Health Insurance Program (CHIP) at higher income levels than adults. Pregnant women, elderly adults in nursing homes, and individuals with disabilities make up a large share of Medicaid spending even though they represent a smaller percentage of total enrollees. Medicaid is funded jointly by the federal government (which covers 50% to 77% of costs, depending on state income levels) and state governments.
Side-by-Side Comparison
Eligibility
Medicare eligibility is based primarily on age (65+) or disability status. You qualify by paying Medicare taxes during your working years — most Americans become automatically eligible at 65. Younger people qualify if they have received Social Security Disability Insurance (SSDI) for 24 months, have ESRD, or have amyotrophic lateral sclerosis (ALS). Income does not affect Medicare eligibility (though it affects premiums).
Medicaid eligibility is based on income and household size. In expansion states, any adult earning up to 138% of FPL qualifies. In non-expansion states, eligibility categories are narrower. Children qualify at higher income levels through CHIP. Assets may also factor into eligibility for certain Medicaid programs, particularly long-term care coverage.
Cost to Beneficiaries
Medicare beneficiaries pay Part B premiums ($185/month standard in 2025), Part D premiums (varies by plan), deductibles ($257 for Part B; $1,676 for Part A inpatient stays in 2025), and coinsurance (typically 20% for Part B services). Medicare Advantage plans may have different cost-sharing structures. There is no out-of-pocket maximum in Original Medicare — one of its most significant gaps — though Medigap supplemental plans and Medicare Advantage plans provide catastrophic protection.
Medicaid has minimal cost sharing. Most beneficiaries pay no premiums and face only nominal copays ($1 to $4 for prescriptions or doctor visits in many states). Federal rules prohibit states from charging premiums to beneficiaries below 150% of FPL, and copays cannot be charged for emergency services, family planning, or children’s services. Medicaid is, for practical purposes, the closest thing to free healthcare in the US system.
Coverage Scope
Medicare covers hospital care, physician services, preventive care, prescription drugs (with Part D), durable medical equipment, lab tests, and mental health services. Notable gaps include routine dental, vision, and hearing care — which Original Medicare does not cover, though many Medicare Advantage plans do. Long-term custodial nursing home care is also not covered by Medicare; it covers only short-term skilled nursing stays (up to 100 days) following a qualifying hospital stay.
Medicaid provides comprehensive coverage that often exceeds Medicare’s scope. Federal rules require coverage of inpatient and outpatient hospital care, physician services, lab tests, nursing facility services, home health services, family planning, and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children. Many states add dental, vision, personal care, and long-term care to their Medicaid programs. Crucially, Medicaid is the primary payer for long-term nursing home care in the US — covering roughly 42% of all long-term care costs nationally, according to MACPAC.
Provider Networks
Medicare is accepted by the vast majority of physicians. About 97% of non-pediatric physicians accept Medicare, according to CMS data. You can see any Medicare-participating provider without a referral under Original Medicare. Medicare Advantage plans, however, use provider networks — typically HMO or PPO structures — that may limit your choices.
Medicaid provider acceptance rates are lower. Low reimbursement rates mean some physicians limit the number of Medicaid patients they see or do not accept Medicaid at all. A MACPAC analysis found that about 74% of office-based physicians accepted new Medicaid patients, compared to 91% for private insurance. Finding specialists can be more challenging with Medicaid, particularly in rural areas. Managed care Medicaid plans (which now cover the majority of Medicaid beneficiaries) use defined provider networks.
Dual Eligibility: When You Qualify for Both
Approximately 12 million Americans are “dual eligibles” — they qualify for both Medicare and Medicaid simultaneously. This typically includes adults 65 and older with low incomes, younger adults with disabilities who also have low incomes, and people with ESRD who meet Medicaid income requirements.
For dual eligibles, Medicare serves as the primary payer for most medical services. Medicaid acts as secondary coverage, picking up costs that Medicare does not — including Medicare premiums, deductibles, copays, and services Medicare does not cover (like long-term care, dental, and vision). This combination provides the most comprehensive coverage available in the US healthcare system.
Dual-eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed specifically for people with both Medicare and Medicaid. These plans coordinate benefits between the two programs, simplifying what can otherwise be a confusing administrative process. If you or a family member is dual eligible, a D-SNP may streamline care and reduce paperwork. You can learn more about how Medicare covers virtual care in our guide on Medicare and telehealth.
Enrollment Differences
Medicare enrollment follows defined periods. The Initial Enrollment Period is a seven-month window around your 65th birthday (three months before, the birthday month, and three months after). The General Enrollment Period runs January 1 through March 31 each year for people who missed their initial window. The Annual Enrollment Period (October 15 through December 7) allows you to switch between Original Medicare and Medicare Advantage or change Part D plans. Late enrollment in Part B or Part D can result in permanent penalty surcharges on your premiums.
Medicaid enrollment is available year-round — there is no open enrollment period. You can apply whenever you believe you qualify. Applications are processed through your state’s Medicaid agency, either online, by phone, or in person. Processing times vary but typically take 30 to 45 days. If approved, coverage can be retroactive up to three months before the application date in some states. If you are denied, you have the right to appeal.
How to Apply for Medicare and Medicaid
For Medicare, you can apply online at SSA.gov, by calling the Social Security Administration at 1-800-772-1213, or by visiting a local Social Security office. If you are already receiving Social Security benefits, you are automatically enrolled in Medicare Part A at 65. You will need to actively enroll in Part B, Part D, and any supplemental or Advantage plans. The State Health Insurance Assistance Program (SHIP) provides free counseling to help you choose Medicare plans.
For Medicaid, apply through your state’s Medicaid agency or through HealthCare.gov (which will route you to your state’s program). You will need proof of income, residency, citizenship or immigration status, and household size. If you are applying for a child, CHIP applications are processed alongside Medicaid. Navigators and community health centers can help with the application process at no charge.
Frequently Asked Questions
Can you have both Medicare and Medicaid?
Yes. About 12 million Americans are “dual eligible” and receive both. Medicare is the primary payer for medical services, while Medicaid helps cover premiums, deductibles, copays, and services Medicare does not cover. Dual-eligible individuals receive some of the most comprehensive coverage in the US healthcare system.
Does Medicare cover nursing home care?
Medicare covers short-term skilled nursing facility care (up to 100 days) after a qualifying three-day hospital stay. It does not cover long-term custodial nursing home care. Medicaid is the primary payer for long-term nursing home care, but eligibility requires meeting income and asset limits. Many families engage in Medicaid planning to qualify for long-term care coverage.
Is Medicaid only for people who do not work?
No. Many Medicaid recipients are working adults whose jobs do not offer affordable health insurance and whose incomes fall below the eligibility threshold. In expansion states, adults earning up to 138% of the federal poverty level qualify — that is about $20,783 for a single person. Retail, food service, and gig economy workers are common Medicaid beneficiaries.
At what age does Medicare start?
Medicare eligibility begins at age 65 for most Americans. You can enroll during the seven-month Initial Enrollment Period around your 65th birthday. Younger people can qualify through SSDI (after a 24-month waiting period), ESRD, or ALS diagnosis. There is no upper age limit for Medicare eligibility.
Does Medicaid cover dental and vision?
It depends on the state. Federal rules require Medicaid to cover dental and vision for children through EPSDT. For adults, dental and vision coverage is optional, and offerings vary widely by state. Some states provide comprehensive adult dental, others cover only emergency dental, and a few provide no adult dental coverage at all. Check your state’s Medicaid program for specifics.
The Bottom Line
Medicaid and Medicare serve different populations through different mechanisms, but both play essential roles in the American healthcare system. Medicare provides health coverage based primarily on age and disability status, funded by payroll taxes and premiums. Medicaid provides coverage based on income, funded jointly by federal and state governments. If you are approaching 65, enroll in Medicare during your Initial Enrollment Period to avoid late penalties. If your income is low, apply for Medicaid at any time through your state’s program. And if you qualify for both, coordinate your benefits — the combination of Medicare and Medicaid provides the most comprehensive protection available. Understanding which program you qualify for, and how to maximize its benefits, is one of the most impactful financial decisions you can make.