Medicare vs. Medicaid: Who Qualifies, What's Covered, and Having Both in 2026

Medicare vs. Medicaid at a glance

The names sound alike, but the two programs are built on different foundations. Medicare is run entirely by the federal government and is tied mainly to age or disability — not income. If you've paid Medicare taxes long enough and you're 65 or older, you generally qualify regardless of how much you earn.

Medicaid is a joint federal-state program for people with limited income and resources. Because each state designs and administers its own Medicaid program within federal rules, both who qualifies and what's covered can look different depending on where you live. Medicaid also pays for some services Medicare typically does not, such as long-term nursing home care and personal care services.

• Medicare: federal, eligibility based on age 65+ or qualifying disability, uniform core rules nationwide
• Medicaid: joint federal-state, eligibility based on income and resources, rules vary by state
• Medicare charges premiums, deductibles, and coinsurance to most enrollees; Medicaid is designed for low-income individuals and charges little or nothing
• You can be enrolled in both at the same time ("dual eligible")

Who qualifies for each program

Medicare eligibility is largely about age and work history. Most people qualify at 65; people under 65 can qualify after receiving Social Security Disability benefits for a set period, or with certain conditions such as ESRD or ALS. Part A is premium-free if you or a spouse paid Medicare taxes for at least 40 quarters (about 10 years). With 30-39 quarters the Part A premium is $311/month in 2026, and with fewer than 30 quarters it is $565/month.

Medicaid eligibility is set by each state and centers on income and resources, with separate pathways for seniors, people with disabilities, pregnant people, children, and families. Because thresholds and rules differ by state, the only reliable way to know if you qualify is to apply through your state's Medicaid agency.

One change to watch: under federal rules, starting January 1, 2027 (and earlier in some states), certain adults must complete at least 80 hours per month of work or other approved activities to qualify for and keep Medicaid coverage. Specifics are still being implemented at the state level, so check your state's guidance before relying on this.

What each program covers

Medicare is organized into parts. Part A covers inpatient hospital and skilled nursing facility stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) bundles these through private plans. Medicare generally does not pay for long-term custodial nursing home care, routine dental, or most vision and hearing services through Original Medicare.

Medicaid often fills exactly those gaps. It can cover long-term services and supports — including extended nursing home stays and in-home personal care — that Medicare doesn't, and depending on the state may add dental, vision, and transportation benefits. Specific Medicaid benefits vary by state, so confirm what's offered where you live.

• Medicare Part A: inpatient hospital, skilled nursing facility, hospice, some home health
• Medicare Part B: doctor visits, outpatient care, preventive services, durable medical equipment
• Medicare Part D: prescription drugs through private plans
• Medicaid: low-income coverage that can include long-term care, personal care, and state-specific extras Medicare omits

Having both: dual eligibility and Medicare Savings Programs

About 12 million people are enrolled in both Medicare and Medicaid — more than 15% of all Medicaid enrollees, according to CMS. People with both coverages are called "dual eligible." In general, Medicare pays first and Medicaid acts as a secondary payer, helping with costs Medicare leaves behind.

There are two broad groups. "Full duals" get complete Medicaid benefits on top of Medicare, including services Medicare doesn't cover. "Partial duals" get help through Medicare Savings Programs (MSPs), which use Medicaid funds to pay certain Medicare costs but don't provide full Medicaid coverage.

MSPs include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individuals (QDWI) programs. Depending on the program, they can pay your Part B premium and, in the case of QMB, also Part A and B deductibles, coinsurance, and copayments. Income and resource limits apply and are set against the federal poverty level, so eligibility depends on your situation and state.

• QMB: helps pay Part A and Part B premiums plus deductibles, coinsurance, and copays
• SLMB and QI: help pay the Part B premium (QI has a limited annual funding cap)
• QDWI: helps pay the Part A premium for certain working people with disabilities who lost premium-free Part A
• Many people who qualify for an MSP also automatically qualify for Extra Help with Part D drug costs

2026 Medicare costs to know

If you have only Medicare, these are the standard 2026 figures. Medicaid or an MSP may reduce or eliminate some of them if you qualify.

These amounts are nationwide standards for Original Medicare. Medicare Advantage and Part D plan costs are set by private insurers and vary by plan.

• Part B: $202.90/month premium and a $283 annual deductible, then you pay 20% coinsurance for most covered services
• Part A inpatient: $1,736 deductible per benefit period; $434/day for hospital days 61-90; $868/day for lifetime reserve days
• Skilled nursing facility: $0 for days 1-20, then $217/day for days 21-100 (per benefit period)
• Part D: a $2,100 annual out-of-pocket cap on covered drugs; national base beneficiary premium of $38.99/month
• Higher earners pay IRMAA surcharges: in 2026 these phase in above MAGI of $109,000 (single) / $218,000 (joint), pushing total Part B to $284.10-$689.90/month and adding $14.50-$91.00/month on Part D