Medicare vs. Medicaid: What's the Difference and Can You Have Both?

If a parent may need long-term care, the key Medicare and Medicaid difference is this: Medicaid offers benefits Medicare doesn't normally cover, like nursing home care and personal care services.1 Medicare is federal health insurance for people 65 or older and some younger people with certain disabilities or conditions, while Medicaid helps cover medical costs for some people with limited income and resources.1 Each state runs its own Medicaid program under general federal rules, so Medicaid eligibility and benefits can vary from state to state.1 Plenty of families end up needing both programs, and the sections below show how the two fit together.

In This Guide

• Medicare vs. Medicaid at a glance
• Who qualifies for Medicare?
• Who qualifies for Medicaid?
• What does each program cost you?
• Which one pays for a nursing home?
• Can you have Medicare and Medicaid at the same time?
• Does the new Medicaid work requirement apply if you have Medicare?
• How do you sign up for each?
• Is there a Medicare vs. Medicaid guide for your state?
• Frequently Asked Questions
• Learn More

Medicare vs. Medicaid at a glance

So here's the whole comparison on one screen. The rows below draw on HHS, Medicare.gov, Medicaid.gov and federal regulations, and each row gets its own section further down.

Who qualifies for Medicare?

Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease).2

The ESRD route has conditions attached, and all of them have to apply. According to Medicare.gov's ESRD page, a person with End-Stage Renal Disease can get Medicare at any age if their kidneys no longer work, they need regular dialysis or have had a kidney transplant, and they meet a work or benefits test.2 That work or benefits test for ESRD Medicare means one of these:

• Work history: The person worked the required amount of time under Social Security, the Railroad Retirement Board or as a government employee.
• Benefits: The person is already getting, or is eligible for, Social Security or Railroad Retirement benefits.
• Family: The person is the spouse or dependent child of someone who meets either of those requirements.2

When to sign up is its own topic, and our Medicare enrollment periods guide walks through it.

Who qualifies for Medicaid?

Medicaid is a different story. Medicare.gov says the rules around who's eligible for Medicaid are different in each state.1 For a person who already has Medicare, the main Medicaid eligibility rules look like this:

• Income and resources: Medicare.gov says that to qualify for Medicaid you generally must meet your state's rules for income and resources, plus other rules like being a resident of the state.5
• Residency: Medicaid beneficiaries generally must be residents of the state in which they're receiving Medicaid.5
• Citizenship: Medicaid beneficiaries must be U.S. citizens or certain qualified non-citizens, such as lawful permanent residents.5
• Age 65 and older: Medicaid eligibility for people 65 and older, or who have blindness or a disability, is generally determined using the income methodologies of Supplemental Security Income (SSI), a program run by the Social Security Administration (SSA).5

Some states, known as 209(b) states, use certain eligibility criteria that are more restrictive than SSI's, though they still largely apply SSI methodologies.5 Because the limits are set state by state, the numbers that matter are the ones for your state, and our Medicaid income limits by state page lists them.

Income a little too high? That isn't always the end of it. Medicare.gov says some states let a person who meets the state's Medicaid resource limit "spend down" income above the state's Medicaid limit by paying non-covered medical expenses and cost sharing, like Medicare premiums and deductibles, until their income is low enough to qualify.5

Timing matters too. Once a person is found eligible, Medicaid coverage starts either on the date of application or the first day of the month of application, and Medicaid may also cover benefits retroactively for up to three months before the month of application if the person would have been eligible then.5 Our Medicaid retroactive eligibility guide covers how that look-back works.

What does each program cost you?

Medicare isn't free for most people. HHS says people with Medicare pay part of the costs through things like monthly premiums for medical and drug coverage, deductibles and coinsurance.1

In 2026, the standard monthly premium for Medicare Part B is $202.90, or higher depending on your income, and you pay the Part B premium each month even if you don't use any Part B-covered services.6 The 2026 Medicare Part B deductible is $283, paid once each year before Original Medicare starts to pay.6 Most people don't get a bill for the Part B premium, because HHS says it's deducted automatically from their Social Security, Railroad Retirement Board or Civil Service Retirement check.6

Medicaid runs close to the other end of the scale. HHS says people with Medicaid usually don't pay anything for covered medical expenses, though they may owe a small co-payment for some items or services.1 And if you qualify for both programs, Medicaid may pick up some of your Medicare costs, which is covered in the section on having both below. The full Medicare price list lives in our guide to Medicare costs.

Which one pays for a nursing home?

Short answer: Medicare pays for short stays of skilled nursing facility care, while nursing home care is a benefit Medicaid offers that Medicare doesn't normally cover.3,1

What Medicare covers in a nursing home

Medicare Part A covers skilled nursing facility (SNF) care only on a short-term, post-acute basis.3 To qualify for Medicare SNF coverage, a person generally needs a qualifying inpatient hospital stay of at least three consecutive days and must enter a Medicare-certified SNF for skilled care related to that stay, generally within 30 days of leaving the hospital.3 Time spent under observation or in the emergency room before admission doesn't count toward Medicare's three-day inpatient stay requirement for SNF coverage, even overnight.3

Here's how the Medicare SNF bill runs in 2026, per benefit period:

• Days 1 to 20: Medicare SNF care costs $0 each day after the 2026 Part A deductible of $1,736, which you don't pay again if you already paid it for a hospital stay in the same benefit period.3
• Days 21 to 100: Medicare SNF care carries a daily coinsurance of $217 in 2026.3
• After day 100: Medicare pays nothing for the SNF stay.3

The bigger limit is custodial care. Medicare does not cover custodial care, meaning non-medical help with daily activities like bathing, dressing and using the bathroom, when that help is the only care a person needs.7 That custodial-care exclusion is the core reason Medicare doesn't pay for long-term stays in a nursing home or assisted living facility, and federal regulation at 42 CFR 411.15(g) excludes custodial care except as needed for hospice care of a terminal illness.7 Medicare.gov points families in one direction here: "Although you’re not eligible for long-term care under Medicare, you may be eligible for it through Medicaid (if you meet eligibility requirements in your state)."3 Our guide to whether Medicare pays for long-term nursing home care goes deeper on the Medicare side.

What Medicaid covers in a nursing home

For a long stay, this is the program that matters. Under federal Medicaid rules, nursing facility services for people 21 and older are a mandatory benefit, as are home health services, so nursing facility services are part of every state's Medicaid plan no matter where your parent lives.4

Help at home is less certain. Home and community-based services (HCBS), such as personal care attendants and adult day care, are optional Medicaid benefits that exist only where a state has chosen to offer them.4 When a state offers HCBS through a waiver rather than its regular Medicaid plan, the state can limit those services to specific groups and cap enrollment, which is why some families hoping to keep a parent at home land on a waiting list.4 Our nursing home Medicaid by state guide covers each state's rules.

One more thing to know now rather than later, before a parent enters a nursing home on Medicaid: federal law requires each state to seek recovery from the estates of certain Medicaid enrollees, including people who were 55 or older when they received nursing facility services or home and community-based services.9 Our Medicaid estate recovery explainer walks through who is affected and the protections that apply.

Can you have Medicare and Medicaid at the same time?

Yes. People who have both Medicare and full-benefit Medicaid coverage are called "dually eligible."5 For a dual eligible, the two programs split the work like this:

• Who pays first: For a dual eligible, Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other health insurance the person has.5
• Prescription drugs: A dual eligible's prescription drugs are covered by Medicare, through automatic enrollment in a Medicare drug plan, and Medicaid may still cover a drug Medicare doesn't in certain situations.5
• Medicare costs: For a person with Medicare and full-benefit Medicaid, depending on the level of Medicaid they qualify for, the state might pay their Medicare deductibles, coinsurance and copayments, plus Part A premiums if they owe one.5

Medicaid.gov says that through the Medicare Savings Programs, Medicaid pays Medicare premiums, deductibles and/or coinsurance for people eligible for both programs.5 The details, including how to apply, are in our guides to dual eligibility and Medicare Savings Programs. For help with Medicare drug costs, Social Security runs Extra Help, and our Extra Help guide explains it.

Does the new Medicaid work requirement apply if you have Medicare?

No. Medicare.gov says that starting January 1, 2027 (or earlier in some states), certain adults must complete at least 80 hours per month of work or other approved activities to qualify for Medicaid and keep their coverage, and that this Medicaid work requirement doesn't apply to people with Medicare.5 So if your mom is on Medicare and applying for Medicaid, the 80-hour rule isn't one of her hurdles.

How do you sign up for each?

Medicare. Your Medicare Initial Enrollment Period is a 7-month window around your 65th birthday: the 3 months before the month you turn 65, that month, and the 3 months after.8 People who start receiving Social Security or Railroad Retirement Board benefits at least 4 months before turning 65 are enrolled in Medicare Part A and Part B automatically, and people not yet collecting those benefits must sign up through the Social Security Administration.8 If you miss your Initial Enrollment Period, the Medicare General Enrollment Period runs January 1 through March 31 each year, and coverage starts the month after you sign up.8

Medicaid. To apply for Medicaid, Medicare.gov directs people to contact their State Medical Assistance (Medicaid) office.5 Our how to apply for Medicaid by state guide lists each state's office and the documents to gather.

Questions along the way. 1-800-MEDICARE (1-800-633-4227) is the official Medicare contact line, and Medicare.gov says callers can reach a real person 24 hours a day, 7 days a week, except some federal holidays; TTY users call 1-877-486-2048.10 For free local counseling and other contacts, see our guide on who to call for Medicare help.

Is there a Medicare vs. Medicaid guide for your state?

Medicaid rules change at the state line, so a state-specific comparison is worth a look if your family lives in one of these states:

• Medicare vs. Medicaid in Florida
• Medicare vs. Medicaid in Georgia
• Medicare vs. Medicaid in Tennessee
• Medicare vs. Medicaid in Texas

For every other state, start with our Medicaid by state guide.

Learn More

Get personalized help figuring out whether Medicare, Medicaid or both cover your parent's care at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.