Can I have both Medicare and Medicaid at the same time?

Yes. Approximately 12.8 million Americans are dually eligible for both Medicare and Medicaid. If you qualify for Medicare based on age or disability and also meet your state's Medicaid income and asset requirements, you can receive benefits from both programs simultaneously. Medicaid typically pays for costs that Medicare does not cover, including long-term care, and it can also pay your Medicare premiums, deductibles, and coinsurance.

Part A is premium-free for most people who paid Medicare taxes for at least 10 years (40 quarters). However, Part B has a standard monthly premium of $185.00 in 2025, and there are deductibles, coinsurance, and copayments for most services. If you want prescription drug coverage, you also need a Part D plan, which carries its own premium. Medicare is not free, but certain low-income programs like Medicare Savings Programs and Extra Help can significantly reduce or eliminate your out-of-pocket costs.

What is a Dual Special Needs Plan (D-SNP)?

A Dual Special Needs Plan is a type of Medicare Advantage plan designed specifically for people who have both Medicare and Medicaid. D-SNPs coordinate benefits between both programs, often providing extra benefits like dental, vision, hearing, transportation, and over-the-counter allowances at little to no additional cost. They simplify the experience of navigating two separate programs by combining coverage into a single plan with a dedicated care coordinator.

Does Medicaid cover nursing home care?

Yes, and this is one of the most important differences between the two programs. Medicaid is the single largest payer of long-term care services in the United States, covering nursing home stays, assisted living (in many states), and home and community-based services for eligible individuals. Medicare, by contrast, only covers short-term skilled nursing facility stays — up to 100 days per benefit period following a qualifying hospital stay — and does not pay for custodial or long-term nursing home care.

What happens to my Medicaid if I turn 65 and become eligible for Medicare?

If you are already on Medicaid when you turn 65, you do not automatically lose Medicaid coverage. You will need to enroll in Medicare Part A and Part B during your Initial Enrollment Period, but if you still meet your state's Medicaid income and asset requirements, you can keep Medicaid as well. Most states require you to enroll in Medicare if you are eligible, because Medicare becomes the primary payer and Medicaid acts as secondary coverage.

Can I qualify for Medicaid if I own a home?

In most cases, yes. Your primary residence is generally exempt from Medicaid's asset calculations, provided the home equity falls below your state's threshold (up to $713,000 or $1,071,000 in 2025, depending on the state). You must intend to return to the home, or a spouse or dependent must be living there. Other assets like bank accounts, investments, and additional properties do count toward Medicaid's asset limits, which vary by state.

Medicare vs. Medicaid: Key Differences Explained (2026 Guide)

Two Programs Born on the Same Day

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments into law, creating both Medicare and Medicaid in a single stroke. More than sixty years later, these two programs together provide health coverage to over 150 million Americans. Yet despite sharing a birthday and a similar name, Medicare and Medicaid are fundamentally different programs that serve different populations, are funded differently, and are administered by different levels of government.

The confusion is understandable. Both are government health insurance. Both cover doctor visits, hospital stays, and prescriptions. Both start with "Medi." But the similarities end there. This guide breaks down everything you need to know about how these two programs differ — and how they can work together.

What Is Medicare?

Medicare is a federal health insurance program primarily for Americans aged 65 and older. It is administered by the Centers for Medicare and Medicaid Services (CMS) and works the same way in every state. Eligibility is based on age or disability — not income.

You qualify if you are 65 or older and a U.S. citizen or permanent resident with at least five years of residency; if you are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months; if you have End-Stage Renal Disease (ESRD) requiring dialysis or a transplant; or if you have ALS, which qualifies you immediately.

Medicare has four parts:

Part A (Hospital Insurance): Inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.
Part B (Medical Insurance): Doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services.
Part C (Medicare Advantage): A private-plan alternative bundling Parts A and B, usually with drug coverage and extras like dental, vision, and hearing.
Part D (Prescription Drugs): Outpatient prescription medications through private plans approved by Medicare.

Approximately 67 million Americans are enrolled in Medicare in 2025. The program is funded through payroll taxes, general federal revenue, and beneficiary premiums.

What Is Medicaid?

Medicaid is a joint federal-state health insurance program for people with limited income and resources. Each state designs and runs its own Medicaid program within broad federal guidelines, so eligibility, benefits, and provider networks vary significantly by state. Each state even gives its program a unique name — Medi-Cal in California, MassHealth in Massachusetts, AHCCCS in Arizona.

Medicaid covers low-income adults, children, pregnant women, elderly individuals, and people with disabilities. In the 40 states (plus D.C.) that expanded Medicaid under the Affordable Care Act, most adults earning up to 138% of the Federal Poverty Level — roughly $20,783 for an individual in 2025 — qualify.

With more than 90 million enrollees, Medicaid is the largest source of health coverage in the United States. It is also the nation's primary payer for long-term care, including nursing home stays that Medicare largely does not cover. Funding is shared between the federal government and states through the Federal Medical Assistance Percentage (FMAP), with poorer states receiving a higher federal match — no less than 50% and as high as 77%.

Key Differences Between Medicare and Medicaid

While both programs provide health insurance, they differ in nearly every fundamental way.

Eligibility

Medicare is based on age (65+) or disability, regardless of income. A billionaire and a retiree on Social Security both qualify on the same terms. Medicaid is based on income and resources — you must fall below your state's thresholds, and in many cases meet asset limits too.

Funding and Administration

Medicare is entirely federal — CMS sets the rules and pays the claims uniformly in all 50 states. Medicaid is a federal-state partnership. Washington sets minimums, but states have enormous flexibility, which is why Medicaid looks completely different in Texas versus New York.

Coverage

Medicare covers hospital care, doctor visits, outpatient services, preventive care, and prescription drugs, but has notable gaps — no long-term custodial care, no routine dental, vision, or hearing under Original Medicare. Medicaid typically provides broader benefits including long-term care, dental, vision, hearing, transportation, and personal care services.

Costs to Beneficiaries

Medicare beneficiaries pay premiums, deductibles, and coinsurance. Part B alone costs $185.00/month in 2025, and Original Medicare has no out-of-pocket maximum. Medicaid has minimal or zero cost-sharing — most enrollees pay nothing, and federal law caps total cost-sharing at 5% of family income.

Provider Access

Over 97% of physicians accept Original Medicare, giving beneficiaries broad nationwide access. Medicaid reimbursement rates are lower, so fewer providers participate and specialist access can be more limited in some areas.

Dual Eligibility: Having Both Medicare and Medicaid

Roughly 12.8 million Americans qualify for both programs simultaneously. These "dual eligibles" tend to have complex health needs and fall into two categories.

Full dual eligibles receive complete Medicaid benefits alongside Medicare. Medicare pays for most acute care while Medicaid wraps around to cover long-term care, dental, vision, transportation, and often pays the beneficiary's Medicare premiums and cost-sharing.

Partial dual eligibles get Medicaid help with some or all Medicare costs — such as premiums and cost-sharing — through Medicare Savings Programs, but do not receive full Medicaid benefits.

Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed specifically for dual eligibles. They coordinate benefits between both programs in a single plan, often adding care coordination, case managers, and extra supplemental benefits at no additional cost.

All dual eligibles automatically qualify for Extra Help (the Low-Income Subsidy), which covers most or all Part D prescription drug costs — including the premium, deductible, and copayments — reducing drug expenses to a few dollars per prescription or less.

How to Qualify for Medicare

There are three primary pathways:

Age: 65 or older, U.S. citizen or permanent resident with five years of residency. Premium-free Part A requires 40 quarters of Medicare-tax-paying work history (yours or your spouse's).
Disability: Under 65 with 24 months of SSDI benefits. ALS qualifies you immediately with no waiting period.
ESRD: End-Stage Renal Disease requiring dialysis or a kidney transplant. Coverage typically begins the fourth month of dialysis, or sooner with a transplant or home dialysis training.

There is no income test for Medicare. Higher earners pay more for Part B and Part D through IRMAA (Income-Related Monthly Adjustment Amount), but no one who meets the eligibility criteria can be denied coverage.

How to Qualify for Medicaid

Medicaid eligibility is more complex because it varies by state and depends on several factors:

Income: States set limits as a percentage of the Federal Poverty Level. Expansion states cover most adults up to 138% FPL. Children often qualify at 200% to 300% FPL through Medicaid and CHIP.
Assets: Some categories (especially elderly and disabled) have asset limits. Your primary home, one vehicle, and personal belongings are usually exempt. The ACA expansion group has no asset test.
Categorical eligibility: You must fall into a covered group — children, pregnant women, parents, elderly adults, or people with disabilities. Expansion states cover most low-income adults ages 19 to 64 regardless.
Residency: You must live in the state where you apply and be a U.S. citizen or qualified non-citizen. Legal permanent residents typically face a five-year waiting period, though some states cover recent immigrants sooner.

What Does Medicare Cover?

Part A covers inpatient hospital stays, skilled nursing facility care (up to 100 days following a qualifying stay), hospice, and limited home health services.

Part B covers doctor visits, outpatient procedures, lab work, diagnostics, durable medical equipment, preventive care, and mental health services. Preventive services like annual wellness visits and cancer screenings are covered at $0.

Part D covers outpatient prescription drugs with a $2,000 annual out-of-pocket cap starting in 2025, insulin capped at $35/month, and all recommended adult vaccines at $0.

The gaps matter. Original Medicare does not cover routine dental, vision, or hearing care; long-term custodial nursing home stays; or most care outside the United States. These gaps drive many beneficiaries toward Medigap supplemental policies or Medicare Advantage plans.

What Does Medicaid Cover?

Federal law requires every state to cover mandatory benefits: inpatient and outpatient hospital services, physician services, lab and X-ray services, nursing facility care, home health, nurse-midwife and nurse-practitioner services, federally qualified health center services, EPSDT services for children under 21, and family planning.

Many states also offer optional benefits: prescription drugs, dental, vision, hearing aids, physical and occupational therapy, personal care services, transportation, and prosthetics.

The most significant difference is long-term care. Medicaid pays for approximately 42% of all long-term care spending nationally — nursing homes, assisted living, home and community-based waiver services, and personal care attendants. For many families, Medicaid is the only realistic way to cover extended nursing home care, which averages over $100,000 per year for a private room.

Costs Comparison

Medicare costs in 2025:

Part A premium: $0 for most (up to $518/month without enough work history)
Part B premium: $185.00/month (more for higher incomes)
Part A deductible: $1,676 per benefit period
Part B deductible: $257/year, then 20% coinsurance with no cap
Part D: average premium ~$46.50/month, $2,000 annual out-of-pocket cap
No out-of-pocket maximum under Original Medicare (MA plans cap at $9,350)

Medicaid costs:

Premiums: $0 for most enrollees
Deductibles: generally $0
Copayments: nominal ($1-$4 if charged at all)
Total cost-sharing capped at 5% of family income by federal law
Zero cost-sharing for children, pregnant women, emergency services, and family planning

The contrast is stark. A Medicare beneficiary without supplemental coverage could face thousands in out-of-pocket costs after a hospitalization. A Medicaid enrollee receiving the same care would likely pay nothing.

How to Apply for Medicare

Automatic enrollment: If you are already receiving Social Security at 65, you are auto-enrolled in Parts A and B. Your card arrives about three months before your birthday.

Manual sign-up: If you are not yet collecting Social Security, apply online at ssa.gov, call 1-800-772-1213, or visit your local Social Security office.

Initial Enrollment Period (IEP): A 7-month window starting three months before your 65th birthday month and ending three months after. Enrolling early ensures coverage begins on the first day of your birthday month. Missing the IEP can trigger permanent late-enrollment penalties.

For disability-based eligibility, enrollment is automatic after 24 months of SSDI (immediately for ALS). ESRD patients should contact Social Security to coordinate timing based on their treatment start date.

How to Apply for Medicaid

Unlike Medicare, Medicaid has no fixed enrollment periods — you can apply any time of year through multiple channels:

HealthCare.gov: The marketplace application screens for Medicaid automatically and forwards qualifying applications to your state.
State Medicaid portal: Every state has a website for direct online applications, document submission, and benefit management.
In person: Apply at your local Department of Social Services or community health center. Navigators and certified counselors offer free assistance.
Mail or phone: Request a paper application from your state Medicaid office or apply by phone.

States must process applications within 45 days (90 for disability-based). If approved, coverage is often retroactive to the application date or up to three months prior — a protection Medicare does not offer.

Medicare Savings Programs

Medicare Savings Programs (MSPs) are state Medicaid programs that help low-income Medicare beneficiaries pay their Medicare costs. They bridge the gap between the two systems and come in four levels:

Qualified Medicare Beneficiary (QMB): Pays Part A premium, Part B premium, and all Medicare deductibles, coinsurance, and copayments. Providers cannot bill QMB beneficiaries for cost-sharing. Income limit: 100% FPL (~$1,255/month individual in 2025).

Specified Low-Income Medicare Beneficiary (SLMB): Pays the Part B premium only. Income limit: 100%-120% FPL (~$1,255-$1,506/month).

Qualifying Individual (QI): Also pays the Part B premium for people with slightly higher income. Funded through a limited block grant. Income limit: 120%-135% FPL (~$1,506-$1,694/month).

Qualified Disabled and Working Individuals (QDWI): Pays the Part A premium for disabled individuals under 65 who returned to work and lost premium-free Part A. Income limit: 200% FPL.

Enrolling in any MSP automatically qualifies you for Extra Help with Part D drug costs. Many eligible people do not realize they qualify — these programs can save thousands per year.

The Bottom Line

Medicare and Medicaid share a name and a mission but are two distinct programs. Medicare is federal, based on age or disability, with premiums and cost-sharing. Medicaid is a federal-state partnership, based on income, with minimal costs to enrollees.

If you are turning 65, enroll in Medicare on time to avoid permanent penalties. If you are struggling financially, check whether Medicaid covers you — even if you already have Medicare. And if you qualify for both, programs like D-SNPs and Medicare Savings Programs can simplify your coverage and dramatically reduce costs.

The most important step is acting. Medicare has strict deadlines. Medicaid has none — you can apply any day and coverage can be retroactive. If you think you qualify for either program, contact Medicare at 1-800-MEDICARE, your state Medicaid office, or a licensed agent who can walk you through your options.

Medicare vs. Medicaid: What's the Difference?