Eligibility and help paying
What is the difference between Medicare and Medicaid?
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Short answer
Medicare is federal health insurance for people 65 and older and some younger people with disabilities, ALS or End-Stage Renal Disease, and it isn't based on income.
Medicaid is a joint federal and state program for people with limited income and resources, and its rules and benefits vary by state.
People who qualify for both are dual eligible: Medicare pays first, and Medicaid can pay Medicare premiums and cost sharing and covers some care Medicare doesn't, such as long-term nursing home care.
How do Medicare and Medicaid differ?
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | The federal government (CMS) | Each state, with federal rules and funding |
| Who qualifies | People 65+, and younger people with disabilities, ALS or ESRD | People with limited income and resources (rules vary by state) |
| Based on income? | No | Yes |
| What you pay | Premiums, deductibles and coinsurance | Little or nothing |
| Long-term nursing home care | Not covered | Covered for people who qualify |
| How to apply | Social Security (ssa.gov) | Your state Medicaid agency |
Can I have both Medicare and Medicaid?
Yes. Millions of people have both and are called dual eligible. Medicare pays first for services it covers, and Medicaid pays after it, often covering Medicare premiums, deductibles and copays, plus services Medicare doesn't cover, like long-term care. People with both automatically qualify for Extra Help with drug costs.
What plans are there for people with both?
Dual-eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans for people with Medicare and Medicaid; some coordinate or combine both programs' benefits. Since 2025, people with Medicaid or Extra Help can switch each month to Original Medicare with a stand-alone Part D plan, and full-benefit dual-eligible people can join an integrated plan in any month.
What if my income is too high for Medicaid?
You may still qualify for a Medicare Savings Program, which pays the Part B premium and sometimes more, or Extra Help with drug costs; their limits are higher than many states' Medicaid limits. How to get help paying for Medicare.
Good to know
More questions people ask
Is Medi-Cal the same as Medicaid?
Does Medicaid pay my Medicare premiums?
Will I lose Medicaid when I get Medicare?
Where do I apply for Medicaid?
Related questions
- Medicare.gov: Medicaid
- Medicare.gov: Special Needs Plans (SNPs)
- Medicare.gov: Medicare Savings Programs
- Medicare.gov: Help with drug costs (Extra Help)
Figures are Medicare’s, set nationally, and were checked against these pages on October 2026. For your own situation, contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048).
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This page was last updated: October 2026.