Medicaid vs. Medicare: What's the Difference and Can You Have Both?

Quick answer: Medicaid and Medicare are separate programs with different rules. Medicaid is free or low-cost coverage for people with low income. Medicare is a federal program mainly for people age 65 and older. Yes, you can have both at the same time.

The Basic Difference

Medicare and Medicaid sound similar, but they are completely different programs run by different rules.

Medicare is a federal health insurance program. You usually qualify because of your age or a disability, not because of your income.

Medicaid is free or low-cost health coverage run by each state with federal funding. You qualify based on your income and other factors like your age or disability status.

Who Qualifies for Medicare

Medicare is primarily for people age 65 and older. You may also qualify if you:

• Are under 65 and have been receiving Social Security disability benefits for 24 months
• Have end-stage renal disease (permanent kidney failure)
• Have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease)

Most people don't need to apply for Medicare. You automatically get it when you turn 65 if you're already receiving Social Security benefits. If you're not yet receiving Social Security, you should sign up for Medicare when you turn 65.

Who Qualifies for Medicaid

Medicaid is for people with low income. The income limits vary by state and by your situation—for example, whether you're a child, an adult, a parent, a pregnant person, an older adult, or a person with disabilities.

In states that expanded Medicaid, most adults aged 19–64 qualify with income up to 138% of the federal poverty level. These income levels come from Medicaid.gov and reflect state decisions as of December 1, 2023.

For 2026, here's what 138% of the federal poverty level means in dollars:

Your state may have different income limits based on your age, family situation, or disability status. You can apply for Medicaid at any time of year. Applying is always free, and only your state Medicaid agency decides if you qualify.

What Each Program Covers

Both programs cover doctor visits and hospital care, but they have different rules about what they pay for.

Medicare typically covers:

• Doctor and specialist visits
• Hospital stays
• Lab tests and imaging (like X-rays)
• Prescription drugs (with Part D)
• Home health care
• Hospice care

Medicaid coverage varies by state, but generally covers:

• Doctor and specialist visits
• Hospital stays
• Lab tests and imaging
• Prescription drugs
• Mental health and substance use treatment
• Dental care
• Vision care

Medicaid often covers more services than Medicare does, especially preventive care, dental care, and vision care. Your state Medicaid program can tell you exactly what's covered in your state.

Can You Have Both Medicaid and Medicare?

Yes. If you qualify for both programs, you can be enrolled in both at the same time. This is sometimes called being "dual eligible."

When you have both:

• Medicare is your primary insurance and pays first
• Medicaid is your secondary insurance and can help pay some costs Medicare doesn't cover
• This can reduce your out-of-pocket costs

You might qualify for both if you're age 65 or older with low income, or if you're under 65, disabled, and have low income.

How to Apply

For Medicare: You usually don't need to apply. You automatically get Medicare when you turn 65 if you're already receiving Social Security benefits. If you're not yet receiving Social Security, sign up for Medicare when you turn 65. Visit Medicare.gov for help or to get more information.

For Medicaid: You can apply through your state Medicaid agency or through HealthCare.gov, which sends your application to the state. The application is free, and the state agency decides if you qualify.

You don't have to choose between programs. If you think you might qualify for either one, applying is free and takes just a few minutes. Use the benefits screener on our site to see what you might be eligible for.

What Happens Next

If you apply for Medicaid, the state will review your application and contact you about the decision. Your income, family size, age, and disability status all matter. If the state approves you, you can usually start using your coverage right away.

For Medicare, your coverage typically starts on the first day of the month you turn 65 or on the first day of the month after you apply, depending on when you sign up.

Common Mistakes to Avoid

• Waiting too long to sign up for Medicare: If you don't sign up when you turn 65, you may face penalties and delayed coverage. Sign up even if you're still working.
• Assuming you don't qualify for Medicaid: Income limits are different in every state and for different groups. You may qualify even if you think you earn too much.
• Not updating your information: If your income, household size, or living situation changes, tell your state Medicaid agency. Your coverage might change.
• Forgetting to apply for both: If you qualify for both, applying for Medicaid won't affect your Medicare, and vice versa. Apply for everything you might qualify for.

Related Help

Want to understand more about health coverage? Check out our guides on Medicare and Medicaid. You can also explore all available benefits or use our calculators to estimate what you might qualify for. If you need help, contact us for support.

Summary

Medicaid and Medicare are different programs that serve different groups. You may qualify for one, both, or neither—it depends on your age, income, and health status. Applying is free, and only the government agency decides if you qualify. Start by checking your eligibility today.