Medicare 101 Series
Medicare · vs Medicaid
Medicare vs Medicaid —
They Sound Alike, They're Not
Two government health programs with names that rhyme. They're structured completely differently — different eligibility, different coverage, different who pays. Some people qualify for both.
Medicare
Eligibility
Age-based (65+) OR disability-based (any age, after 24 months of disability benefits). You qualify based on YOUR work history (or your spouse's).
Coverage
Hospital (A), Doctor visits (B), Advantage (C), Drugs (D). Does NOT cover long-term care or most dental/vision/hearing.
Cost
Part A usually free if you worked 10+ years. Part B premium (~$175/mo in 2025). Part D + Medigap have separate premiums.
Administered by
Federal government (CMS).
Medicaid
Eligibility
Income-based. Limits vary by state. Some states cover anyone below 138% of the federal poverty level; others cover only specific categories (children, pregnant women, elderly, disabled).
Coverage
Broader than Medicare. INCLUDES long-term care (the big difference), most dental/vision, transportation to medical appointments, and more — but state-dependent.
Cost
Often free or very low cost for those who qualify. Some states have small copays for certain services.
Administered by
Joint federal-state. Each state runs its own Medicaid program with federal partial funding.
Federal poverty level — the common Medicaid threshold
In states that expanded Medicaid under the ACA, anyone earning at or below 138% of FPL typically qualifies. Other states have stricter rules limited to specific categories.
What about both? — Dual Eligibility
People who qualify for both Medicare and Medicaid are called dual-eligible (sometimes "Medi-Medi"). This is fairly common for retirees on fixed income.
Dual-eligible enrollees often get the best of both: Medicare covers their hospital + medical care, and Medicaid picks up Medicare's out-of-pocket costs (premiums, deductibles, copays) AND adds the things Medicare doesn't cover (long-term care, transportation, dental, vision). There are even special Medicare Advantage plans designed for dual-eligibles called D-SNPs (Dual Special Needs Plans) — usually $0 premium with extra benefits.
Not sure what you qualify for?
We'll check your eligibility for Medicare, Medicaid, and dual-eligible programs in your state — and find plans designed for your specific situation.
Keep Reading
More in Medicare
Sources
medicare.gov · medicaid.gov · cms.gov
Educational content only. Not financial advice. Eligibility rules vary by state. Consult a licensed advisor for your specific situation.