Medicare vs. Medicaid — What They Are, Who Qualifies, and How They Work Together

Medicare and Medicaid sound like the same program with a spelling change. They aren't. One is a federal program mostly tied to age and work history. The other is a state-run program tied to income and household size. Millions of Americans qualify for both — and the combination is powerful when you use it correctly.

The one-line difference

• Medicare is federal. You qualify at 65 (or earlier with certain disabilities). Coverage doesn't care about your income.
• Medicaid is state-run with federal funding. You qualify based on income, household size, and (in some states) age or disability.

Who qualifies

Medicare eligibility is straightforward: age 65, or under 65 with 24 months of Social Security Disability, ALS, or End-Stage Renal Disease. Medicaid eligibility is set by each state, using federal minimums as a floor. In most states an individual qualifies at roughly 138% of the federal poverty level, but the number, asset limits, and covered groups vary widely.

What each one covers

Medicare covers hospital stays (Part A), doctor visits (Part B), and — through Part D or a Medicare Advantage plan — prescription drugs. It does not cover routine dental, vision, hearing aids, or long-term custodial care in a nursing home.

Medicaid covers those Medicare gaps for people who qualify: long-term nursing home care, in-home caregivers, adult dental (in many states), and transportation to medical appointments. For families with children it also covers well- child visits, immunizations, and CHIP.

"Dual-eligible" — the best-kept secret

If you qualify for both Medicare and Medicaid, you're called "dual-eligible." Medicare pays first for medical services; Medicaid picks up premiums, deductibles, copays, and services Medicare doesn't cover — often bringing your total out-of-pocket cost to zero or near-zero. Many dual-eligible clients also qualify for a Dual-Eligible Special Needs Plan (D-SNP), which bundles both benefits into one card with extras like transportation and grocery allowances.

The four Medicare Savings Programs

Even if your income is too high for full Medicaid, a Medicare Savings Program can still pay some or all of your Part B premium (that's about $185/month back in your pocket in 2026):

• QMB — pays Part A/B premiums, deductibles, and coinsurance.
• SLMB — pays the Part B premium only.
• QI — pays the Part B premium (limited enrollment).
• QDWI — pays Part A for certain disabled workers.

How to check whether you qualify

Every state runs its own Medicaid application, usually through the state's Department of Human Services or Medicaid agency. Medicaid.gov's beneficiary directory links each state's application. The federal Medicare Savings Program page lists income limits for the four programs above.

Educational only. Income limits and state rules change every year; confirm current numbers with your state Medicaid agency, Social Security, or a licensed agent before applying.