Medicaid vs. Medicare: how they differ, and how to get help from both
Medicare is federal health insurance for people 65 and older and some younger people with disabilities. Most people pay premiums, deductibles and coinsurance. Medicaid is run by each state for people with limited income, and it costs little or nothing for those who qualify. Some people have both, and then Medicaid helps pay their Medicare costs.
Apply for free on your state's official site
Medicaid and CHIP applications are free, and you can apply any time of year. Apply directly with your state Medicaid agency, or through HealthCare.gov if your state uses it.
All states: Medicaid agency websites
- Alabama: Alabama Medicaid (medicaid.alabama.gov)
- Alaska: Alaska Medicaid (health.alaska.gov)
- Arizona: Arizona Health Care Cost Containment System (AHCCCS) (azahcccs.gov)
- Arkansas: Arkansas Medicaid (humanservices.arkansas.gov)
- California: Department of Health Care Services (Medi-Cal) (dhcs.ca.gov)
- Colorado: Health First Colorado (healthfirstcolorado.com)
- Connecticut: Connecticut Medicaid (HUSKY) (portal.ct.gov)
- Delaware: Delaware Medicaid & Medical Assistance (dhss.delaware.gov)
- District of Columbia: DC Medicaid (districtdirect.dc.gov)
- Florida: Florida Agency for Health Care Administration (ahca.myflorida.com)
- Georgia: Georgia Medicaid (dch.georgia.gov)
- Hawaii: Hawaii Med-QUEST Division (medquest.hawaii.gov)
- Idaho: Idaho Department of Health & Welfare (healthandwelfare.idaho.gov)
- Illinois: Illinois Department of Healthcare and Family Services (hfs.illinois.gov)
- Indiana: Indiana Family and Social Services Administration (in.gov)
- Iowa: Iowa Department of Human Services (hhs.iowa.gov)
- Kansas: KanCare (kancare.ks.gov)
- Kentucky: Kentucky Cabinet for Health and Family Services (Kynect) (chfs.ky.gov)
- Louisiana: Healthy Louisiana (ldh.la.gov)
- Maine: Maine Department of Health and Human Services (MaineCare) (maine.gov)
- Maryland: Maryland Department of Health (health.maryland.gov)
- Massachusetts: MassHealth (mass.gov)
- Michigan: Michigan Department of Health & Human Services (michigan.gov)
- Minnesota: Minnesota Department of Human Services (mn.gov)
- Mississippi: Mississippi Division of Medicaid (medicaid.ms.gov)
- Missouri: Missouri Department of Social Services (dss.mo.gov)
- Montana: Montana Department of Public Health and Human Services (dphhs.mt.gov)
- Nebraska: Nebraska Department of Health and Human Services (dhhs.ne.gov)
- Nevada: Nevada Department of Health and Human Services (dhhs.nv.gov)
- New Hampshire: New Hampshire Department of Health and Human Services (dhhs.nh.gov)
- New Jersey: New Jersey Department of Human Services (state.nj.us)
- New Mexico: New Mexico Human Services Department (hsd.state.nm.us)
- New York: New York State Department of Health (health.ny.gov)
- North Carolina: North Carolina Medicaid (medicaid.ncdhhs.gov)
- North Dakota: North Dakota Department of Human Services (applyforhelp.nd.gov)
- Ohio: Ohio Department of Medicaid (medicaid.ohio.gov)
- Oklahoma: Oklahoma Health Care Authority (oklahoma.gov)
- Oregon: OregONEligibility (one.oregon.gov)
- Pennsylvania: Pennsylvania Department of Human Services (dhs.pa.gov)
- Rhode Island: Rhode Island Executive Office of Health and Human Services (eohhs.ri.gov)
- South Carolina: South Carolina Health Connections Medicaid (scdhhs.gov)
- South Dakota: South Dakota Department of Social Services (dss.sd.gov)
- Tennessee: Tennessee Department of Health (TennCare) (tn.gov)
- Texas: Texas Health and Human Services (hhs.texas.gov)
- Utah: Utah Department of Health Medicaid (medicaid.utah.gov)
- Vermont: Vermont Health Connect (portal.healthconnect.vermont.gov)
- Virginia: Virginia Department of Medical Assistance Services (dmas.virginia.gov)
- Washington: Washington State Health Care Authority (hca.wa.gov)
- West Virginia: West Virginia Department of Health and Human Resources (dhhr.wv.gov)
- Wisconsin: Wisconsin Department of Health Services (dhs.wisconsin.gov)
- Wyoming: Wyoming Department of Health (health.wyo.gov)
State agency links from Medicaid.gov's directory of state Medicaid agencies, checked October 19, 2026.
Your options, cheapest first
Medicaid and Medicare are both public programs, but they serve different people. Start at the top. Stop at the first card that fits you. New to Medicaid? Read how Medicaid works first.
Medicaid (any age)
- Who qualifies
- People with limited income who meet their state's rules. That includes children, pregnant women, parents, older adults and people with disabilities. Some states also cover other adults with low income.
- What it costs
- Little or nothing for most care. States may charge small copays, but a family's total premiums and copays can't be more than 5% of its income (42 CFR 447.56 (law.cornell.edu)).
- How to get it
- Use the state links above or HealthCare.gov. You can apply any time of year.
A Medicare Savings Program (if you have Medicare)
- Who qualifies
- People with Medicare whose income and savings are under the limits in the table below. Some states use higher limits.
- What it costs
- Applying costs nothing. Most of these programs pay your Part B premium. One of them, the Qualified Medicare Beneficiary (QMB) program, also pays your deductibles and coinsurance.
- How to get it
- Apply through your state Medicaid agency.
Extra Help with drug costs (if you have Medicare)
- Who qualifies
- People with Medicare and limited income and savings. You get it without applying if you have full Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program that pays your Part B premium.
- What it costs
- In 2027 you pay no more than $5.80 for a generic drug and $14.40 for a brand-name drug at your plan's pharmacies (Medicare.gov).
- How to get it
- Apply through Social Security, online (ssa.gov) or by phone. Steps are in "How to apply" below.
Medicare on its own
- Who qualifies
- People 65 and older who meet its citizenship or residency rules. Also younger people who have had Social Security disability benefits for 24 months, or who have kidney failure (ESRD) or ALS (Lou Gehrig's disease). Income does not decide if you qualify.
- What it costs
- Most people pay no premium for Part A. In 2026 the Part B premium is $202.90 a month, or more at higher incomes (Medicare.gov).
- How to get it
- Through Social Security. Many people who already get Social Security are signed up on their own.
A few words you will see: a premium is what you pay each month to have coverage. A deductible is what you pay for care before the plan starts to pay. Coinsurance is your share of each bill after that, such as 20%.
Side by side: how the two programs differ
| Question | Medicaid | Medicare |
|---|---|---|
| Who is it for? | People with limited income who meet state rules, at any age | People 65 and older, plus some younger people with a disability, ESRD or ALS |
| Who runs it? | Each state, under federal rules. It is a joint federal and state program. | The federal government |
| Is there an income test? | Yes. Limits depend on your state, your household and your group, such as pregnancy or disability. | No. But people with higher incomes pay more for Part B. |
| What do you pay? | Little or nothing. Any copays are small, and family costs are capped at 5% of income. | Part B: $202.90 a month and a $283 deductible each year, then usually 20%. Part A: a $1,736 deductible for each hospital benefit period. |
| Long-term care, like help with bathing and dressing | Nursing home care is a required benefit for people who qualify. States may also pay for personal care. | Not covered. Medicare helps pay for short-term care in a skilled nursing facility, but only up to day 100 in a benefit period. After that, you pay all costs. |
| Dental, eyeglasses, hearing aids | For adults, dental care and eyeglasses are optional for states, so it depends on where you live. Children under 21 get dental, vision and hearing care, such as eyeglasses and hearing aids, through a required benefit called EPSDT. | Original Medicare does not cover most dental care, eye exams for glasses or hearing aids. |
| Where do you apply? | Your state Medicaid agency or HealthCare.gov, any time of year | Social Security. Many people are enrolled on their own. |
What this means: Medicare is tied to age or disability, and almost everyone pays something for it. Medicaid is tied to income, and it changes from state to state. The cost figures come from Medicare's 2026 cost page (medicare.gov). The benefit rows come from Medicaid.gov's list of required and optional benefits, its page on care for children (EPSDT) (medicaid.gov) and Medicare's list of what it doesn't cover (medicare.gov). Medicare says that people who need long-term care may get it through Medicaid (medicare.gov) if they meet their state's rules.
Which one am I? Answer these in order
- Are you 65 or older? If yes, you can likely get Medicare, as long as you meet its citizenship or residency rules. Then go to question 4.
- Are you under 65 and getting Social Security Disability Insurance (SSDI)? Medicare starts after you have had disability benefits for 24 months. With ALS, it starts the month your benefits start (Medicare.gov). During the wait, you may be able to get Medicaid. If Medicaid turns you down, a Marketplace plan may work until Medicare starts (HealthCare.gov).
- Do you get SSI, or is your income low? SSI is a different program from SSDI. In many states, people on SSI get Medicaid without a separate application. In others, they need to sign up (HealthCare.gov). With low income and no Medicare, Medicaid is the program to check. Apply even if you are not sure.
- Do you have Medicare, and is money tight? Check the Medicare Savings Program and Extra Help limits below. If your income is close, apply anyway. Your state may use higher limits.
- Do you need long-term care at home or in a nursing home? Medicare will not pay for it. Ask your state Medicaid agency about long-term care. Some states let you "spend down" by counting medical bills if your income is a little too high (Medicare.gov).
Having both: how dual eligibility works
You can have Medicare and Medicaid at the same time if you meet the rules for both. People with both are called "dually eligible." In federal fiscal year 2025, nearly 12.5 million people had both, on average. About 32% of them were under 65, usually because of a disability. These figures come from the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare (CMS report to Congress, July 2026 (cms.gov)).
Who pays first
Medicare pays first for the care it covers. Medicaid pays last, after Medicare and any other insurance you have. Medicaid may also pay for care Medicare skips, such as nursing home care and personal care (Medicare.gov).
Full help or partial help
- Full Medicaid. Your state pays your Part B premium. Based on your level of Medicaid, it may also pay your deductibles and coinsurance. You get Extra Help with drug costs without applying.
- Partial help. You get help only with Medicare costs, through a Medicare Savings Program. In fiscal year 2025, CMS counted 72% of people with both programs as having full Medicaid and 28% as having partial help.
Either way, your state checks from time to time that you still qualify. Open every letter from your state Medicaid agency, and see what to do when a renewal notice comes.
Your drugs come from Medicare
If you have both programs, a Medicare drug plan covers your prescriptions, not Medicaid. You are put in a Medicare drug plan if you don't pick one. If Medicare won't cover a drug, Medicaid may still cover it in some cases (Medicare.gov). Some Medicare Advantage plans are built for people with both programs. A counselor at your State Health Insurance Assistance Program (SHIP) (shiphelp.org) can walk you through them at no cost.
Medicaid work rules don't apply to people with Medicare
Starting January 1, 2027, or earlier in some states, some adults must show at least 80 hours a month of work or other approved activities to get or keep Medicaid. This rule does not apply to people with Medicare (Medicare.gov). If you don't have Medicare, our main Medicaid guide explains who must report hours and who is exempt.
Help paying Medicare costs: 2026 limits
These programs are for people who already have Medicare. Medicare Savings Programs are run by your state. Extra Help is a Medicare program, and you apply for it through Social Security. The limits below are the federal limits for 2026.
| Program | What it pays | Income limit, one person | Income limit, married couple | Savings limit, one person / couple |
|---|---|---|---|---|
| QMB (Qualified Medicare Beneficiary) | Part B premium, deductibles, coinsurance and copays (and the Part A premium, if you pay one) | $1,350 a month | $1,824 a month | $9,950 / $14,910 |
| SLMB (Specified Low-Income Medicare Beneficiary) | Part B premium only | $1,616 a month | $2,184 a month | $9,950 / $14,910 |
| QI (Qualifying Individual) | Part B premium only. You must reapply every year. | $1,816 a month | $2,455 a month | $9,950 / $14,910 |
| QDWI (Qualified Disabled and Working Individual) | Part A premium only, for some people with a disability who went back to work | $5,405 a month | $7,299 a month | $4,000 / $6,000 |
| Extra Help | Most costs of a Medicare drug plan | $23,940 a year (about $1,995 a month) | $32,460 a year (about $2,705 a month) | $18,090 / $36,100 |
How to read this: the program rows come from Medicare.gov's Medicare Savings Programs page. The Extra Help row comes from Medicare.gov's Extra Help page. Limits are a little higher in Alaska and Hawaii. Some states use higher limits or don't count some income or savings, so Medicare.gov says to apply even if you think you are over. With QMB, doctors and hospitals that take Medicare can't bill you for Medicare-covered care, though you may owe a small Medicaid copay. QI is first come, first served each year. Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa.
Worked example (2026 limits). A 68-year-old lives alone. She gets $1,500 a month from Social Security and has $4,000 in the bank. Her income is over the QMB limit of $1,350. But it is under the SLMB limit of $1,616, and her savings are under $9,950. If her state approves her, it pays her Part B premium of $202.90 a month. That is $2,434.80 over a year. She also gets Extra Help with drug costs without a separate application.
How to apply
- Medicaid: use your state's official application (links at the top of this page) or HealthCare.gov. Applying is free, any time of year.
- Medicare Savings Program: apply through your state Medicaid agency. Find yours in Medicaid.gov's list of state agencies.
- Extra Help: apply through Social Security. You can use Social Security's Extra Help page (ssa.gov). Or call 1-800-772-1213 (TTY 1-800-325-0778) on a weekday to set up a time to apply. When you apply, Social Security sends your details to your state to start a Medicare Savings Program application too, unless you say no (Medicare.gov).
- Medicare: if you don't get it on your own, sign up through Social Security. See Medicare's getting-started page (medicare.gov) to find your path.
What happens after you apply
- Medicaid and Medicare Savings Programs. In most cases, your state must decide within 45 days. If you apply based on a disability, it can take up to 90 days (42 CFR 435.912 (law.cornell.edu)). The state may ask for more proof. Send it by the date in the letter.
- Extra Help. You get a letter that says what you will pay. If you don't have a Medicare drug plan, you are put in one, and you can pick a different one. Once you qualify, you keep Extra Help through December 31, even if your income changes during the year (Medicare.gov).
What to have ready
- Your Medicare card, if you have one, and your Social Security number.
- Proof of income for you and your spouse, such as your Social Security benefit letter, pension statements or pay stubs.
- Recent bank statements, your last tax return, and the balances of any IRA, 401(k) or other savings or investments.
- Proof of where you live, such as a lease or a utility bill.
- Proof of U.S. citizenship or immigration status, if your state asks for it.
- Cards for any other health coverage you have.
- Recent medical bills, if you may need to "spend down" or have unpaid bills.
What to say when you call your state Medicaid agency
"Hi, I have Medicare and my income is limited. I'd like to apply for a Medicare Savings Program, and I'd like to know if I qualify for full Medicaid too. Which form should I use, and what proof do you need from me?"
Want a person to help? Your local SHIP (shiphelp.org) gives one-on-one Medicare counseling, and it costs you nothing. SHIP counselors can also help you apply for Extra Help. You can also call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), 24 hours a day, 7 days a week, except some federal holidays (Medicare.gov).
If you're turned down or your help is cut
- Medicaid or a Medicare Savings Program said no. Your state must let you ask for a fair hearing. You get a set time to ask, which can't be more than 90 days from the date the notice was mailed (42 CFR 431.221 (law.cornell.edu)). Your letter gives your exact deadline, so read it the day it arrives.
- Your state is ending or cutting help you already have. Ask for a hearing before the date the change starts. Your coverage usually stays the same until the hearing decision. If you lose, the state may ask you to pay back the cost of care you got during that time (42 CFR 431.230 (law.cornell.edu)).
- Extra Help said no. You have 60 days from the day you get Social Security's letter to ask for a review. Call 1-800-772-1213, visit a Social Security office, or send your request by mail or fax (20 CFR 418.3630 (law.cornell.edu)). If your income or savings drop later, you can apply again at any time.
- The QI program was full. Apply again next year. If your income is lower, ask whether you qualify for QMB or SLMB instead.
- You still need care now. Community health centers charge on a sliding scale based on income; some visits cost little or nothing. You can also ask a nonprofit hospital about its financial assistance policy, or look for a free clinic.
If you're under 65 and don't have Medicare
Medicare isn't for you yet, so start with Medicaid. If you qualify for Medicaid, you can't get savings on a Marketplace plan (HealthCare.gov). If you don't qualify, a Marketplace plan may help. Depending on your income, a premium tax credit (a tax credit that lowers your monthly premium) can cut the cost. You can get a Marketplace plan to cover you until your Medicare starts.
Once you have Medicare, you don't need a Marketplace plan, and you can't get savings on one. It is against the law for someone who knows you have Medicare to sell you a Marketplace plan. Marketplace coverage also doesn't end on its own when Medicare starts, so update your application to end it (HealthCare.gov). This guide does not send anyone to a Medicare plan seller. For Medicare choices, use SHIP or 1-800-MEDICARE. The FreedInsure box at the end of this page is only for people under 65 who don't have Medicare.
Find it near you (official and nonprofit finders)
Common questions
- Can you have Medicare and Medicaid at the same time?
- Yes. If you meet the rules for both, you can have both. You are then called dually eligible. Medicare pays first, and Medicaid pays last, after Medicare and any other insurance. In fiscal year 2025, nearly 12.5 million people had both, on average, according to CMS.
- Does Medicaid pay the Medicare Part B premium?
- It can. If you have full Medicaid, or you qualify for the QMB, SLMB or QI program, your state pays your Part B premium. In 2026 that premium is $202.90 a month for most people. Apply through your state Medicaid agency.
- Is Medicaid only for people 65 and older?
- No. Medicaid covers people of any age who meet their state's rules, such as children, pregnant women, parents and people with disabilities. Medicare is the program that is tied mainly to turning 65.
- Who pays first, Medicare or Medicaid?
- Medicare pays first for care it covers. Medicaid pays last. Medicaid may also pay for care Medicare doesn't cover, such as long-term care in a nursing home, if you qualify in your state.
- Can I keep a Marketplace plan after I get Medicare?
- Usually only until Medicare starts. A Marketplace plan can cover you until then. Once you have Medicare Part A or a Medicare Advantage plan, you can't get savings on a Marketplace plan, such as the premium tax credit. Marketplace coverage doesn't end on its own, so update your Marketplace application to end it. You can report your Medicare start date up to 3 months early. See HealthCare.gov's Medicare page.
To apply for Medicaid or CHIP, use your state's official application or HealthCare.gov. Applying is free. FreedInsure can't enroll you in Medicaid or CHIP.
Sources
- Medicare.gov, Parts of Medicare (includes 'What's the difference between Medicare & Medicaid?'), accessed October 19, 2026
- Medicare.gov, Get started with Medicare, accessed October 19, 2026
- Medicare.gov, Which path is right for me? (disability, ESRD, ALS), accessed October 19, 2026
- Medicare.gov, Costs (2026 Part A and Part B amounts), accessed October 19, 2026
- Medicare.gov, Medicare Savings Programs (2026 income and resource limits), accessed October 19, 2026
- Medicare.gov, Help with drug costs (Extra Help 2026 limits and 2027 copays), accessed October 19, 2026
- Medicare.gov, Medicaid (for people with Medicare; dual eligibility; 2027 work requirement note), accessed October 19, 2026
- Medicare.gov, Long-term care, accessed October 19, 2026
- Medicare.gov, What's not covered by Original Medicare, accessed October 19, 2026
- CMS Medicare-Medicaid Coordination Office, FY 2025 Report to Congress (July 2026) (cms.gov), accessed October 19, 2026
- Medicaid.gov, Mandatory & optional Medicaid benefits, accessed October 19, 2026
- 42 CFR 447.56, Limitations on premiums and cost sharing (Cornell LII) (law.cornell.edu), accessed October 19, 2026
- 42 CFR 431.221, Request for hearing (Cornell LII) (law.cornell.edu), accessed October 19, 2026
- Medicaid.gov, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), accessed October 19, 2026
- Social Security Administration, Apply for Medicare Part D Extra Help (ssa.gov), accessed October 19, 2026
- 42 CFR 435.912, Timely determination of eligibility (Cornell LII) (law.cornell.edu), accessed October 19, 2026
- 42 CFR 431.230, Maintaining services pending a hearing (Cornell LII) (law.cornell.edu), accessed October 19, 2026
- 20 CFR 418.3630, Requesting review of a Part D subsidy (Extra Help) decision (Cornell LII) (law.cornell.edu), accessed October 19, 2026
- HealthCare.gov, Medicaid & CHIP coverage, accessed October 19, 2026
- HealthCare.gov, Medicare and the Marketplace, accessed October 19, 2026
- HealthCare.gov, SSDI & Medicare coverage, accessed October 19, 2026
- HealthCare.gov, SSI Disability & Medicaid coverage, accessed October 19, 2026
- SHIP, State Health Insurance Assistance Programs (shiphelp.org), accessed October 19, 2026
- Medicare.gov, Talk to someone (1-800-MEDICARE), accessed October 19, 2026
Part of: Medicaid