Medicare vs Medicaid: What Is the Difference
Medicare is federal health insurance you earn by age (65) or disability, no matter your income. Medicaid is a state-run program for people with limited income and assets, at any age. About one in five people on Medicare also qualify for Medicaid. Those dual-eligible beneficiaries get help with Medicare premiums and cost sharing, and can join special Medicare Advantage plans built for them.
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | Federal government (CMS) | Each state, under federal rules |
| Who qualifies | Age 65+, or under 65 with a disability, ALS or ESRD | Low income and limited assets; rules differ by state |
| What it costs you | Part B premium ($202.90 in 2026), deductibles, 20% coinsurance | Usually free or very low cost |
| Covers | Hospital, medical, drugs (with Part D) | Hospital, medical, drugs, and long-term care such as nursing homes |
| Long-term care | Up to 100 days of skilled nursing after a hospital stay only | Yes, including nursing home care, when you qualify |
When you qualify for both
If you are on Medicare and your income and assets are low enough, you can also get Medicaid. Medicare pays first, Medicaid pays second, and together they can cover nearly all of your costs. In Utah, Medicaid eligibility and applications run through the Department of Workforce Services; each state sets its own limits.
Help that sits between the two
- Medicare Savings Programs (QMB, SLMB, QI): state programs that pay your Part B premium, and for QMB also your deductibles and coinsurance, if your income is under the state limit.
- Extra Help (the Part D Low-Income Subsidy): pays most of your Part D premium and lowers your copays to a few dollars per prescription. Anyone on Medicaid or a Medicare Savings Program gets it automatically.
- Dual Eligible Special Needs Plans (D-SNPs): Medicare Advantage plans designed for people with both programs, with care coordination and extra benefits.
What people mix up
Medicare does not pay for long-term nursing home care; Medicaid does. Medicare is not free; Part B has a premium. And Medicaid is not only for people under 65: a large share of nursing home residents are over 65 and on both programs.
Source: Medicare.gov, Medicaid and Medicare dual eligibility.
Medicare 101: the complete guide
Every topic a person new to Medicare needs, each on its own page, written and reviewed by Christian Brindle.
Questions people ask about Medicare vs Medicaid: What Is the Difference
Can you have Medicare and Medicaid at the same time?
Yes. People who qualify for both are called dual eligible. Medicare pays first and Medicaid pays second, and they can join a Dual Eligible Special Needs Plan.
Does Medicare pay for nursing home care?
Only up to 100 days of skilled nursing care after a qualifying hospital stay, with a daily coinsurance of $217 for days 21 to 100 in 2026. Long-term custodial nursing home care is paid by Medicaid for people who qualify, not by Medicare.
What is a Medicare Savings Program?
A state program that pays your Part B premium, and in the QMB level also your Medicare deductibles and coinsurance, if your income is below the state limit.
What is Extra Help?
The Part D Low-Income Subsidy: it pays most of your drug plan premium and reduces copays to a few dollars. People on Medicaid get it automatically; others apply through Social Security.
Is Medicaid the same in every state?
No. Each state sets income and asset limits and benefits within federal rules, so eligibility in Utah differs from Idaho or Arizona.
Last updated: · Reviewed by Christian Brindle, CEO and Founder. Published by the Everything Senior Insurance Data Desk. Sources: Medicaid, Medicare.gov.