Medicare FAQ

Medicare vs. Medicaid: What's the Difference?

Medicare is a federal health insurance program primarily for people 65 and older (or with certain disabilities), funded and run the same way nationwide regardless of income. Medicaid is a joint federal and state program that provides coverage based on income and financial need, with eligibility rules and benefits that vary by state. Some people qualify for both at once — this is called being 'dual-eligible.'

How Is Medicare Different From Medicaid?

• Who it's for: Medicare covers people 65+ or with certain qualifying disabilities, regardless of income. Medicaid covers people and families with limited income and resources, regardless of age.
• Who runs it: Medicare is entirely federal — the rules are the same in every state. Medicaid is run jointly by the federal government and each state, so eligibility and covered benefits vary by where you live.
• How you pay: Medicare involves premiums, deductibles, and coinsurance, though many costs can be supplemented by a Medigap or Medicare Advantage plan. Medicaid typically has little to no cost to the enrollee.

Can You Have Both Medicare and Medicaid?

Yes — this is called being dual-eligible. If you qualify for both, Medicaid often helps cover costs Medicare doesn't, such as long-term custodial care, and can also help pay Medicare premiums and cost-sharing through a Medicare Savings Program. Dual-eligible individuals are also often eligible for Special Needs Plans (D-SNPs) — Medicare Advantage plans specifically designed to coordinate both types of coverage.

Which One Do I Need?

Most people don't choose between them — eligibility is based on your age/disability status (Medicare) and separately on your income and resources (Medicaid). If you're turning 65, you'll generally need to enroll in Medicare regardless of whether you also qualify for Medicaid. A licensed agent or your state's Medicaid office can help confirm exactly what you qualify for.

Does Medicaid Cover Things Medicare Doesn't?

Yes — this is one of the most valuable parts of dual-eligibility. Medicaid often covers long-term custodial care in a nursing home, which Original Medicare generally does not cover beyond a limited skilled-nursing benefit after a qualifying hospital stay. Medicaid may also cover certain services, like non-emergency transportation to appointments, that fall outside typical Medicare benefits.

How Do I Find Out If I Qualify for Medicaid?

Medicaid eligibility and income limits vary significantly by state, so the fastest way to find out is checking directly with your state's Medicaid agency. If you're already enrolled in Medicare and think you might also qualify for Medicaid or a Medicare Savings Program, a licensed agent can help you understand what to check and how the two programs would work together in your situation.