Medicaid vs. Medicare: Key Differences, Costs and Dual Eligibility
Reviewed October 10, 2026. The main difference between Medicaid vs. Medicare is who each program is for. Medicare is federal health insurance for people 65 and older and for some younger people with disabilities, end-stage renal disease or ALS, whatever their income. Medicaid is a joint federal and state program for people with limited income and resources, and each state sets many of its own rules.
Quick answer: Medicare is based mainly on age or disability and has premiums, deductibles and coinsurance. Medicaid is based on income (and for some groups, assets) and usually costs little or nothing. Many people qualify for both, and when you have both, Medicare pays first and Medicaid can help with Medicare’s costs.
Medicaid vs. Medicare at a glance
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | Federal government (CMS) | Each state, under federal rules, with federal and state funding |
| Who qualifies | People 65+, people under 65 on disability benefits for 24 months, people with ESRD or ALS | People with limited income and resources: children, pregnant people, parents, people with disabilities, older adults and, in expansion states, most low-income adults |
| Income test | No | Yes (and an asset test for many older and disabled people) |
| Typical cost | Part B premium $202.90 a month in 2026, plus deductibles and coinsurance | Usually no premium; small or no copays |
| Rules nationwide? | Same core rules in every state | Varies a lot by state |
| Long-term care | Doesn’t cover long-term custodial care | Main public payer for nursing home care for people who qualify |
| Enrollment | Through Social Security; set enrollment periods | Through your state Medicaid agency; apply any time |
What is Medicare?
Medicare is federal health insurance. You can get it if you’re 65 or older and meet citizenship or residency rules. Medicare.gov says you can qualify earlier if you’ve received Social Security disability benefits for 24 months, if you have ALS (coverage starts when disability benefits begin), or if you have end-stage renal disease.
- Part A (hospital insurance): about 99% of people pay no premium. The 2026 inpatient deductible is $1,736 per benefit period. People who buy Part A pay $311 or $565 a month in 2026, depending on work history.
- Part B (medical insurance): the 2026 standard premium is $202.90 a month and the deductible is $283. After that you usually pay 20%.
- Part C (Medicare Advantage): private plans that cover Parts A and B, often with drug coverage and extras.
- Part D (drug coverage): out-of-pocket drug costs are capped at $2,100 in 2026.
The 2026 Medicare Trustees Report counts about 69.3 million Medicare enrollees in 2025. CMS hasn’t announced the 2027 Part B premium and deductible yet; they’re usually released in the fall. For a full walkthrough, read what Medicare Part C is and Medicare costs and how to sign up.
What is Medicaid?
Medicaid is health coverage for people with limited income and resources. Federal law requires states to cover certain groups, including low-income families, qualified pregnant women and children, and people who get Supplemental Security Income (SSI). States can cover other groups too. Under the Affordable Care Act, states can also cover adults with income up to 133% of the federal poverty level, which works out to 138% with a standard 5% income disregard.
- 2026 federal poverty guideline: $15,960 for one person and $21,640 for two (48 states and DC). 138% of $15,960 is about $22,025 a year.
- Expansion: medicaid.gov’s latest map shows 40 states plus DC had adopted the ACA expansion.
- Enrollment: 73.2 million people were enrolled in Medicaid and CHIP in June 2026, according to medicaid.gov.
Income limits differ by state and group. See our guides to checking whether you qualify for Medicaid and signing in to your state’s Medicaid portal.
Medicare vs. Medicaid coverage: what each pays for
Both cover hospital stays, doctor visits, lab tests and many other medical services. The big differences are in the extras:
- Long-term care: Medicare covers only short skilled nursing stays after a hospital stay. Medicaid covers long-term nursing home care and many home- and community-based services for people who qualify. See Medicaid for nursing home care.
- Dental, vision and hearing: Original Medicare doesn’t cover routine care. Medicaid covers dental for children, and many states cover some adult dental and vision.
- Transportation: Medicaid covers rides to medical appointments. Original Medicare generally doesn’t.
- Costs: Medicare has premiums and cost-sharing. Medicaid usually has little or none.
Can you have Medicare and Medicaid together?
Yes. People who qualify for both are called dual eligibles. Medicare pays first, and Medicaid pays second for services both cover. Medicaid can also pay for things Medicare doesn’t, such as long-term care.
Even if your income is too high for full Medicaid, you may get help through a Medicare Savings Program, run by your state Medicaid agency:
| Program | What it pays | 2026 monthly income limit (individual / couple) |
|---|---|---|
| QMB | Part A and B premiums, deductibles, coinsurance and copays | $1,350 / $1,824 |
| SLMB | Part B premium | $1,616 / $2,184 |
| QI | Part B premium | $1,816 / $2,455 |
The 2026 resource limit for all three is $9,950 for an individual and $14,910 for a couple, and some states use higher limits. Anyone in a Medicare Savings Program automatically qualifies for Extra Help with Part D drug costs. For 2026, Medicare.gov lists Extra Help limits of $23,940 income and $18,090 resources for an individual. Read more about Medicare Savings Programs, Extra Help and dual eligibility.
Many dual eligibles join a Dual Eligible Special Needs Plan (D-SNP), a Medicare Advantage plan built for people with both programs. See Medicare Special Needs Plans.
Medicaid changes coming in 2027
The 2025 reconciliation law (Public Law 119-21) changes Medicaid for adults in the ACA expansion group. According to CMS and medicaid.gov:
- Work and community engagement requirement, starting January 1, 2027 (states may start earlier): expansion adults aged 19 to 64 who aren’t pregnant or on Medicare must show 80 hours a month of work, community service, a work program or at least half-time school, or monthly earnings of at least 80 times the federal minimum wage. Exemptions include parents and caretakers of a child 13 or under or of a disabled person, people who are medically frail, veterans with a total disability rating, American Indians and Alaska Natives, and others.
- Renewals every 6 months for expansion adults, for renewals starting on or after January 1, 2027.
- Shorter retroactive coverage: 1 month for expansion adults and 2 months for other groups, for applications on or after January 1, 2027.
- Cost-sharing of up to $35 per service for expansion adults above 100% of poverty, starting October 1, 2028 (primary care and behavioral health are exempt).
These rules don’t apply to people who are on Medicare. Our guides to Medicaid policy changes and Medicaid renewal explain what to do.
Which program should you apply for?
- Turning 65 or on disability for 24 months: sign up for Medicare through Social Security. If your income is low, also apply to your state Medicaid agency for Medicaid or a Medicare Savings Program.
- Under 65 with low income: apply for Medicaid through your state or HealthCare.gov.
- Needing nursing home care: Medicare won’t pay for long stays; Medicaid may, if you meet income and asset rules.
Frequently asked questions
Is Medicaid the same as Medicare?
No. Medicare is federal insurance based on age or disability. Medicaid is a state-run program based on financial need.
What is the difference between Medicare and Medicaid for seniors?
Almost every senior gets Medicare. Seniors with limited income and assets may also get Medicaid, which can pay Medicare premiums and cost-sharing and cover long-term care.
Does Medicaid replace Medicare?
No. If you have both, Medicare pays first and Medicaid fills in.
Will Medicaid pay my Medicare premium?
If you qualify for full Medicaid or a Medicare Savings Program, your state usually pays the Part B premium ($202.90 a month in 2026).
Do the 2027 Medicaid work requirements apply to Medicare enrollees?
No. They apply to adults aged 19 to 64 in the expansion group who aren’t on Medicare.
Do all states have the same Medicaid benefits?
No. States must cover certain benefits but choose others, such as adult dental, and set their own income limits for many groups.
This article is general information. Medicare365 is not affiliated with or endorsed by any U.S. government agency.
Sources
- CMS: 2026 Medicare Parts A and B premiums and deductibles
- Medicare.gov: Medicare costs
- Medicare.gov: Get started with Medicare
- Medicare.gov: Medicare Savings Programs
- Medicare.gov: Help with drug costs (Extra Help)
- CMS: 2026 Medicare Trustees Report
- Medicaid.gov: Eligibility
- Medicaid.gov: Medicaid and CHIP enrollment highlights
- Medicaid.gov: Medicaid expansion state map
- Federal Register: 2026 HHS poverty guidelines
- HealthCare.gov: Medicaid expansion and you
- CMS: Medicaid community engagement requirement fact sheet
- Medicaid.gov: Overview of 2025 legislation (P.L. 119-21)
- SSA: Extra Help with Medicare prescription drug costs