Understanding the difference between Medicare and Medicaid

People often confuse Medicare with Medicaid because their names sound similar, but they are not the same. The two programs differ in several important ways. The following information will help you understand the difference between Medicare, a federal program for people over 65 or with certain disabilities; and Medicaid, a state-run program for low-income individuals and families. By learning more about these programs, you can decide which one is right for you and your health care needs.

Medicare overview

Medicare is a federal insurance program for people 65 and older or those with disabilities or end-stage renal disease. It consists of four parts that are either provided by the federal government or private insurance companies. Medicare Part A (hospital) and Part B (doctor) are provided by the federal government. Medicare Part C (Medicare Advantage) and Medicare Part D (prescription drug) are offered through private insurance companies.

Learn more about Medicare basics.

Medicaid overview

Medicaid, also known as Medical Assistance, is a public health insurance program that provides free or low-cost health coverage to eligible low-income individuals and families. It is jointly funded by the federal government and state governments but is managed by individual states. This means the specific benefits and eligibility requirements can vary from state to state. Medicaid covers a wide range of health care services, including doctor visits, hospital stays, long-term care, and prevention services.

Medicare versus Medicaid: Key differences

Frequently asked questions

If you’re wondering about having both Medicare and Medicaid, these frequently asked questions can help you understand how these programs work together, and which one pays for your health care.

Can you have both Medicare and Medicaid?

Yes, you can qualify for both Medicare and Medicaid at the same time. This is called dual eligibility. To qualify, individuals usually need to meet specific income and health requirements set by each program. Medicare-eligible individuals with low income or limited resources qualify for both Medicare and Medicaid, allowing access to a wide range of health care services.

If you have Medicare and Medicaid, which is primary?

If you have both Medicare and Medicaid, Medicare is the primary payer. This means that Medicare pays for your health care services first, and Medicaid covers the costs Medicare doesn’t fully cover. This includes copays, deductibles, and services not covered by Medicare, like dental and vision services. In some situations, Medicaid may be the primary payer depending on the services you receive and rules in your state.

Learn more about Medicare and Medicaid

Discover more about Medicare and which plan is right for you with our additional resources.

The Four Parts of Medicare 

Medicare Basics 

Learn More About Medical Assistance: UPMC for You