Last fact-check: July 27, 2026 · Primary sources: Medicare.gov, SSA and Medicaid.gov
Quick answer
Medicare is federal health insurance generally for people 65 or older and some younger people with qualifying disability or permanent kidney failure. Medicaid is a joint federal-state program for eligible people with limited income and other state-defined qualifications. A person can have both.
Key takeaways
- Medicare eligibility is not generally based on low income; Medicaid eligibility is administered under state income, resource and category rules.
- When someone has both, Medicare generally pays first for Medicare-covered services and Medicaid pays last.
- Full-benefit Medicaid pays the Part B premium and may also pay Medicare cost sharing.
Medicare versus Medicaid
| Question | Medicare | Medicaid |
|---|---|---|
| Administration | Federal health-insurance program | Joint federal-state program |
| Main eligibility path | Age 65+, qualifying disability, or certain kidney-failure situations | State income, resource, residency and coverage-group rules |
| Coverage structure | Parts A, B, C and D | State benefits within federal requirements and options |
| Long-term services | Limited coverage under specific conditions | May cover qualifying nursing-home and personal-care services |
| If the person has both | Generally pays first for Medicare-covered services | Generally pays after Medicare and other insurance |
| Part B premium | Normally owed by the enrollee | Full-benefit Medicaid pays it for a dual-eligible person |
Who can have both programs?
Medicare calls people with Medicare and full-benefit Medicaid “dually eligible.” For Medicare-covered care, Medicare pays first and Medicaid pays last. Medicaid may pay deductibles, coinsurance or copayments depending on the coverage level and state rules.
A full-benefit Medicaid recipient with Medicare automatically receives Extra Help for prescription-drug costs. Medicare remains responsible for Medicare drug coverage; Medicaid may cover certain drugs or services Medicare does not.
Why state rules matter
State variation: Medicaid eligibility and covered services are not identical nationwide. Federal law requires certain groups, while states also choose optional groups and methods. Use the state Medicaid agency for a final decision.
Medicaid can cover services Medicare does not normally cover, including qualifying nursing-home and personal-care services. A person whose income appears too high may still have a spend-down or medically needy pathway in some states.
How to apply
- Use Social Security to enroll in Medicare Parts A and B when eligible.
- Contact the State Medical Assistance office for Medicaid.
- Provide income, resource, residency and household information requested by the state.
- If approved for both, verify the Part B premium and cost-sharing assistance.
- Keep notices from Medicare, Medicaid and any plan; each controls a different part of coverage.
Related guides
Official sources
- SSA — Who can get and how to sign up for Medicare
- Medicare — Medicaid and dual eligibility
- Medicaid.gov — Eligibility policy
Editorial status: This guide has been checked against the cited official sources. Independent subject-matter review has not been completed. Program roles and dual-eligibility payment order were checked against the linked federal sources on July 27, 2026. State agencies make Medicaid decisions. The Guru Gazette is independent and is not affiliated with Medicare, Medicaid, CMS or SSA.
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