Medicare vs. Medicaid: What’s the Difference?
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Medicare and Medicaid are government health insurance programs. They can overlap, but they're run by different levels of government and generally serve different populations.
The main difference between Medicare and Medicaid is that Medicare covers people 65 and older, while Medicaid covers people with low income. Both programs cover people with certain disabilities.
The rules for eligibility, costs and coverage also vary between the programs.
Here’s what you need to know about the differences between Medicare and Medicaid.
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Difference between Medicare and Medicaid
Medicare | Medicaid | |
|---|---|---|
Who qualifies? | People with low income. Certain children, pregnant people and people with disabilities. | |
What does it cost? | Usually involves premiums, deductibles and coinsurance or copays. (Depends on the coverage you choose.) | Usually free or small premiums and copays. (Depends on your state and income.) |
What does it cover? | Part A: Hospital, hospice and certain home health care. Part B: Outpatient care and preventive services. Part D: Prescription drugs. Medicare Advantage: A bundled alternative purchased from private companies to cover services from Parts A, B and usually D. » MORE: The parts of Medicare | In all states: Inpatient and outpatient hospital care, nursing home care, labs, X-rays, screenings, family planning and home health. In certain states: Prescription drugs, clinic/office visits, dental care, vision care and therapies. |
Are dependents covered? | Generally, no. In certain cases, eligibility can extend to a spouse or former spouse. | Yes. Children and dependent individuals with certain disabilities are covered by every state Medicaid program. |
Who runs it? | Federal government. | Federal and state governments. |
What is Medicare?
Medicare is health insurance for people 65 and older and individuals with certain disabilities. Medicare is run by the federal government, so it works the same everywhere in the U.S.
There are two ways to get Medicare coverage:
Original Medicare: Part A and Part B. Original Medicare is run by the federal government. It covers inpatient and outpatient care at any health care provider that accepts Medicare (almost all do). Most people also buy a Medicare Part D plan to add prescription drug coverage.
Medicare Advantage: Part C. Medicare Advantage is a bundled alternative to Original Medicare sold by private insurance companies. Medicare Advantage plans must cover at least as much as Part A and Part B, but most add some benefits. Most Medicare Advantage plans also include prescription drug coverage.
» MORE: Medicare vs. Medicare Advantage
What is Medicaid?
Medicaid is a government assistance program that covers health care costs for people with low income and certain children, people with disabilities and pregnant people.
The federal government sets certain rules for Medicaid, so some aspects work the same everywhere. Unlike Medicare, though, states administer their own Medicaid programs, so some aspects work differently from state to state.
You can enter your information at healthcare.gov/lower-costs to see whether you qualify for Medicaid based on your state’s rules.
Can you have Medicare and Medicaid?
Yes, you can have Medicare and Medicaid. Qualifying for both is called “dual eligibility.” A person who qualifies for both programs might be referred to as “dual eligible” or “dually eligible.”
If you have Medicare and Medicaid, both work together to cover your health care costs. Generally, Medicare pays first, then Medicaid covers the remaining costs.
Medicaid might also cover certain Medicare premiums and out-of-pocket costs, depending on how you qualify.
