Medicare vs Medicaid
Updated September 2026 · 2026 figures from CMS and Medicare.gov
Medicare is federal health insurance mainly for people 65 and older and some people with disabilities, regardless of income. Medicaid is a joint federal and state program for people with low income and limited resources, of any age. You can have both.
Medicare vs Medicaid at a glance
| Medicare | Medicaid | |
|---|---|---|
| Who qualifies | Age 65+, or younger with SSDI for 24 months, ESRD or ALS | Low income (and often limited assets); rules vary by state |
| Who runs it | Federal government (CMS) | Each state, within federal rules |
| Cost to you | Premiums, deductibles and coinsurance | Little or nothing |
| Long-term nursing home care | No (only short-term skilled care) | Yes, for those who qualify |
| Home and community-based care | Limited | Often, through state waivers |
| Dental, vision, hearing | Not in Original Medicare | Varies by state |
| Where to apply | Social Security | Your state Medicaid agency |
Dual eligibility: having both
About 12 million people qualify for both programs. Medicare pays first, and Medicaid covers what's left — usually premiums, deductibles, coinsurance and services Medicare doesn't cover, such as long-term care. People with full Medicaid automatically get Extra Help with drug costs and can join a Dual Eligible Special Needs Plan (D-SNP).
Help if you're in between
If your income is too high for full Medicaid but still limited, a Medicare Savings Program may pay your Part B premium — and sometimes your deductibles and coinsurance too. Income limits are higher than for Medicaid.
Medicaid and long-term care
Medicaid is the main payer for long-term nursing home care in the US. Eligibility for long-term care Medicaid has strict income and asset rules and a 5-year look-back on asset transfers. Rules vary by state; a local elder-law attorney or your State Health Insurance Assistance Program (SHIP) can help.
Frequently asked questions
What is the main difference between Medicare and Medicaid?
Medicare is based on age or disability and run federally; Medicaid is based on financial need and run by each state.
Can you have Medicare and Medicaid at the same time?
Yes. People who qualify for both are called dual eligible; Medicare pays first and Medicaid covers remaining costs.
Does Medicare pay for nursing homes?
Only short-term skilled nursing care after a hospital stay. Medicaid can pay for long-term nursing home care for people who qualify.