Medicare vs Medicaid and how to know which one fits you

Medicare and Medicaid sound almost the same, and both help pay for health care, so it's no surprise people mix them up. Even people who have used one for years aren't always sure which is which, or whether they could have both.

Here's the short answer. Medicare is federal health insurance based mainly on age or disability, while Medicaid is health coverage run by each state for people with limited income and resources. Some people qualify for both at the same time, and that combination can lower health costs considerably.

Medicare vs Medicaid at a glance

The biggest difference comes down to one question: Medicare asks how old you are or whether you have a qualifying disability, while Medicaid asks how much income and resources you have.

How Medicare works

Medicare is split into parts, each covering a different kind of care.

• Part A covers hospital stays, skilled nursing after a hospital stay, and hospice. Most people pay no premium for it if they or a spouse paid Medicare taxes long enough while working.
• Part B covers doctor visits, outpatient care, lab work and medical equipment. Most people pay a monthly premium.
• Part C, also called Medicare Advantage, is a private plan approved by Medicare that bundles Parts A and B, and usually D.
• Part D covers prescription drugs through private plans.

If you're approaching 65, mark your calendar. Your first chance to sign up is a seven-month window around your 65th birthday, and signing up late for Part B can mean a higher premium for as long as you have it.

Getting Medicare through disability

You don't have to be 65. People who receive Social Security Disability benefits (SSDI) generally get Medicare after 24 months of disability benefits, and enrollment is usually automatic. People with ALS get Medicare as soon as their disability benefits begin, and people with end-stage renal disease can qualify under separate rules.

How Medicaid works

The federal government sets basic requirements for Medicaid, and each state builds its own program on top of them. That's why Medicaid can have a different name where you live, such as Medi-Cal in California, and why two people with the same income in different states may get different answers.

Most states have expanded Medicaid to cover more adults with low incomes, while others cover mainly specific groups, such as children, pregnant women, older adults and people with disabilities. One of Medicaid's most important roles is paying for long-term care, including nursing home care and services that help people stay in their own homes.

Medicaid eligibility isn't permanent. States review it regularly, usually once a year, and a renewal notice that goes unanswered can end your coverage. Keeping your mailing address current with your state Medicaid office is one of the simplest ways to protect it.

Can you have Medicare and Medicaid at the same time

Yes. People who qualify for both are called dual eligible, and millions of Americans are. It usually happens when someone on Medicare also has limited income and resources.

When you have both, Medicare pays first for services it covers. Medicaid then can help pay what's left, such as premiums, deductibles and coinsurance, and may cover services Medicare doesn't. For example, someone on Medicare who needs help at home with daily tasks might find Medicare doesn't pay for that kind of care, while their state's Medicaid program does.

If you're dual eligible, show both cards at every appointment and pharmacy visit. Providers can only bill each program correctly when they know you have both.

Help with Medicare costs most people never hear about

You don't need full Medicaid to get help with Medicare bills. Two programs are built for people on Medicare with limited income, and many who qualify never apply.

Medicare Savings Programs

These programs help pay your Part B premium, and for some people, Part A and B deductibles, coinsurance and copays too. They're run by your state Medicaid office, and their income and resource limits are often higher than full Medicaid's. A sign worth checking: if your Part B premium takes a noticeable bite out of your Social Security payment each month, you may want to ask your state about these programs.

Extra Help

Extra Help lowers what you pay for prescription drugs under Part D, including premiums, deductibles and copays. You apply through Social Security, online or by phone. If you already get Medicaid or a Medicare Savings Program, you automatically qualify. If you've ever split pills or skipped a refill because of the cost, this program is worth a look.

Find out what you may qualify for

Sorting out which of these programs fits you can take hours on the phone. Radar, Turnout's free benefits scan, checks your situation against health coverage programs and others in about three minutes, so you can see your options before you call anyone. The scan doesn't apply for you or change any coverage you already have.

Run a free benefits scan

Once your coverage is in place, using it well is its own job. A healthcare advocate can coordinate between your doctors, keep track of appointments and refills, and sort out bills that don't look right.

Trusted resources

• Get started with Medicare (Medicare.gov): when to sign up, how enrollment works and how to avoid late penalties.
• What Medicare covers (Medicare.gov): look up whether a specific test, service or item is covered.
• Medicaid eligibility (Medicaid.gov): the federal rules and a path to your state's program.
• Medicaid and CHIP (HealthCare.gov): check whether you may qualify and apply in your state.
• Medicare Savings Programs (Medicare.gov): what each program pays and how to apply.
• Extra Help (Social Security): apply for help with prescription drug costs.
• State Health Insurance Assistance Program (SHIP): free, unbiased one-on-one Medicare counseling in your state.

Turnout is not affiliated with Medicare, Medicaid or any government agency, and this article is general information, not medical, legal or financial advice.

Frequently asked questions

Can I lose Medicaid when I turn 65

Turning 65 doesn't end Medicaid on its own. Your state may review your eligibility under the rules for older adults, which in many states include limits on savings and other resources. You'll generally also be expected to sign up for Medicare, with Medicaid working alongside it if you still qualify.

Do I have to sign up for Medicare if I have Medicaid

In most cases, yes. Medicaid pays after other coverage, so states typically expect you to enroll in Medicare once you're eligible. If you qualify for a Medicare Savings Program, your state may pay your Part B premium for you.

Is Medicare Advantage the same as Medicaid

No. Medicare Advantage is a private plan that delivers your Medicare benefits. Some Medicare Advantage plans, called Dual Eligible Special Needs Plans, are designed specifically for people who have both Medicare and Medicaid and coordinate the two.

Who can help me compare my options for free

Your State Health Insurance Assistance Program offers free counseling from trained volunteers and staff who don't sell insurance. For Medicaid questions, your state Medicaid office can explain local rules and check your application status.

Your next step

Knowing which program does what is the hard part, and now you have it. Take three minutes to run a free benefits scan and see which coverage and cost programs may fit you.

It's your turn.

Ghost Markdown card for the comparison table (paste this into a Markdown card in place of the table above)

| | Medicare | Medicaid |
| --- | --- | --- |
| Who runs it | The federal government | Each state, with federal funding and rules |
| Who it's for | Mainly people 65 and older, plus some younger people with disabilities | People with limited income and resources, of any age |
| How you qualify | Age, disability, or certain conditions such as end-stage renal disease or ALS | Income, household size and, for some groups, savings and other resources |
| What it covers | Hospital stays, doctor visits, outpatient care and prescription drugs | Varies by state; often includes doctor and hospital care plus long-term care services Medicare generally doesn't cover |
| What you may pay | Premiums, deductibles and coinsurance for most people | Little or nothing for covered care; some states charge small copays |
| Where to apply | Social Security, or automatic if you already get Social Security benefits | Your state Medicaid office or HealthCare.gov |