Comparison

Medicaid vs Medicare 2026: Key Differences Explained

Q: What is the difference between Medicaid and Medicare?

Medicare is a federal health program for people 65+ or with certain disabilities regardless of income. Medicaid is a federal-state program for low-income individuals at any age. The key difference: Medicare is age/disability-based, Medicaid is income-based. Many low-income seniors qualify for both (dual eligible) and Medicaid can pay Medicare premiums and cost-sharing.

Q: Can I have both Medicaid and Medicare?

Yes. People who qualify for both are called 'dual eligible.' About 12 million Americans are dual eligible in 2026. When you have both, Medicare pays first and Medicaid pays remaining cost-sharing. Medicaid may also cover services Medicare doesn't, like long-term care, dental, and vision. If you're on Medicare with low income, check if you qualify for a Medicare Savings Program through Medicaid.

Q: Does Medicaid cover what Medicare does not?

Yes. Medicaid covers many services Medicare typically doesn't: long-term care (nursing homes), personal care assistance, dental, vision, hearing, and more. States vary in what optional services they cover. For dual-eligible individuals, Medicaid acts as a secondary insurer that fills in Medicare gaps.

Q: Who qualifies for Medicaid but not Medicare?

Most working-age adults with low income. Medicaid is available to children, pregnant women, low-income adults, and people with disabilities at any age — not just 65+. In expansion states, any adult with income at or below 138% FPL may qualify for Medicaid, regardless of whether they are disabled or have a work history.

June 30, 2026 · 5 min read

Medicare covers Americans 65+ and people with certain disabilities — regardless of income. Medicaid covers low-income individuals at any age. The two programs are often confused, but they have very different rules for who qualifies and what they cover.

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Side-by-side comparison

	Medicaid	Medicare
Who qualifies	Low-income individuals (any age)	Adults 65+ or with qualifying disability
Based on	Income and (sometimes) assets	Age or disability + work/SSA history
Administered by	Federal + state governments	Federal government only
Monthly premium	$0 for most enrollees	$202.90/month (Part B, 2026)
Copays/deductibles	None or minimal	Part A: $1,736 deductible; Part B: $283 deductible
Long-term care	Yes (nursing home, home care)	Limited (max 100 days skilled nursing)
Dental/vision	Many states: yes	Generally no (Medicare Advantage may add)
Prescription drugs	Covered in most states	Part D (separate coverage, additional premium)
Income limits	138% FPL (expansion states)	None

Medicare: the basics

Medicare has four parts:

Part A (hospital): Free for most people with 40+ quarters of work. $1,736 deductible per benefit period in 2026.
Part B (outpatient): $202.90/month premium in 2026. Covers doctor visits, labs, preventive care. $283 annual deductible.
Part C (Medicare Advantage): Private plans bundling A+B, often with extras (dental, vision, gym).
Part D (prescription drugs): Separate plans from private insurers. Premiums vary.

SSDI recipients qualify for Medicare after a 24-month waiting period. People with End-Stage Renal Disease or ALS qualify sooner.

Medicaid: the basics

Medicaid is jointly run by the federal government and each state. Benefits vary by state, but the basics are consistent: low/no premiums, low/no copays, and broad coverage including long-term care. In expansion states, adults up to 138% FPL qualify.

SSI recipients are automatically enrolled in Medicaid in most states. See full Medicaid income limits by state →

Check if you qualify for one or both

Many low-income seniors qualify for both Medicaid and Medicare. Our free screener helps you understand what you're entitled to.

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Dual eligible: having both

About 12 million Americans qualify for both Medicare and Medicaid — called "dual eligible." When you have both, Medicare pays first; Medicaid covers remaining cost-sharing. Benefits of dual eligibility:

Medicare premiums paid by Medicaid (through Medicare Savings Programs)
All Medicare deductibles and copays covered by Medicaid
Long-term care covered by Medicaid (not Medicare)
Dental, vision, and hearing covered by Medicaid in many states
Extra Help for Part D prescriptions

Common questions

What is the difference between Medicaid and Medicare?

Medicare = federal, age/disability-based, any income. Medicaid = federal-state, income-based, any age. Many low-income seniors qualify for both.

Can I have both Medicaid and Medicare?

Yes — "dual eligible" status. About 12 million Americans qualify for both. Medicare pays first; Medicaid covers remaining costs and services Medicare doesn't cover (like long-term care).

Does Medicaid cover what Medicare does not?

Yes — long-term nursing home care, personal care, and in many states dental, vision, and hearing. Medicare's nursing home benefit is limited to 100 days skilled care per benefit period.

Who qualifies for Medicaid but not Medicare?

Most working-age adults with low income. Medicare requires age 65+ or a qualifying disability with work history. Medicaid covers anyone at or below the income limit, regardless of age or work history.

Related guides

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