The names sound alike and both were created by the same 1965 law, which is most of the reason people mix them up. But they answer different questions. Medicare asks how old you are or whether you have a qualifying disability. Medicaid asks how much money you have.
That single difference drives everything else: who runs the program, what you pay, what gets covered, and where you go to sign up. This guide lays the two side by side using current 2026 figures, then covers the roughly 12 million Americans who are enrolled in both at once.
Medicare vs. Medicaid at a Glance
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | Federal government (CMS), same rules in every state | Joint federal-state program; each state runs its own version within federal rules |
| Who qualifies | Age 65+, or under 65 with a qualifying disability, ESRD, or ALS. Income is irrelevant | Based on income (and for some pathways, assets). Rules and limits vary by state |
| Monthly premium (2026) | $0 Part A for about 99% of enrollees; $202.90 standard Part B premium | $0 for nearly everyone. States cannot charge premiums below 150% of the federal poverty level |
| Deductibles (2026) | $1,736 per hospital benefit period (Part A); $283 per year (Part B) | Nominal at most. Federal maximum nominal deductible is a few dollars |
| Typical visit cost | 20% coinsurance on most Part B services after the deductible | $4 or less for a routine outpatient visit at or below 100% FPL |
| Out-of-pocket cap | None under Original Medicare | 5% of household income across all premiums and cost sharing combined |
| Long-term custodial care | Not covered | Covered; nursing facility services are a mandatory benefit |
| Enrollment window | Initial, general, and special enrollment periods apply | Any time of year. No open enrollment |
| Where you apply | Social Security Administration | Your state Medicaid agency or HealthCare.gov |
Sources: the CMS 2026 Parts A and B fact sheet released November 14 2025, Medicare.gov’s 2026 cost tables, and Medicaid.gov’s cost sharing and benefits pages, all read September 2026.
Who Runs Each Program
Medicare is federal. A Part B premium is $202.90 in Ohio and $202.90 in Oregon. The hospital deductible is $1,736 everywhere. When Congress or CMS changes a number, it changes for all 60-plus million enrollees on the same day.
Medicaid is a partnership. The federal government sets a floor of required benefits and consumer protections and pays a share of the bill, and each state builds its own program on top of that floor. That is why the answer to almost any specific Medicaid question begins with “it depends on your state.” As of May 2026, 73.5 million people were enrolled in Medicaid and CHIP across the 50 states and DC, per Medicaid.gov’s enrollment highlights, with 66.4 million in Medicaid and 7.1 million in CHIP.
The state-by-state variation is real but bounded. Nursing facility services, inpatient and outpatient hospital care, lab and X-ray, physician services, family planning, federally qualified health center services, and non-emergency medical transportation are all mandatory benefits every state must cover. Dental care, prescription drugs, eyeglasses, and physical therapy are optional, which is why dental and vision coverage differ so sharply across state lines. Our full benefits breakdown goes deeper.
Who Qualifies
Medicare eligibility is a status test. You generally qualify at 65 if you or your spouse paid Medicare payroll taxes for at least 10 years, or earlier if you have received Social Security disability benefits for 24 months, or immediately with ALS or end-stage renal disease. A millionaire turning 65 qualifies for Medicare.
Medicaid eligibility is an income test, and in expansion states the test is simple. HealthCare.gov states the rule plainly: if your household income is below 133% of the federal poverty level you qualify, and because of how the calculation works it comes out to 138%. Forty-one states including DC have adopted that expansion; ten have not. In non-expansion states, adults without children usually cannot get Medicaid at any income.
There is a second Medicaid door that has nothing to do with the income test above. Seniors and people with disabilities seeking long-term care go through an asset-tested pathway with its own limits, lookback rules, and spend-down math. We cover the income side in Medicaid income limits for 2026 and the asset side in Medicaid spend-down.
What You Pay
This is the sharpest contrast between the two programs.
Under Original Medicare in 2026, per CMS and Medicare.gov: the Part B standard premium is $202.90 a month, the Part B annual deductible is $283, and most Part B services carry 20% coinsurance with no annual out-of-pocket ceiling. Part A is premium-free for roughly 99% of enrollees, but the inpatient deductible is $1,736 per benefit period and you can trigger it more than once in a calendar year. Days 61 through 90 of a hospital stay cost $434 a day, lifetime reserve days cost $868 a day, and skilled nursing days 21 through 100 cost $217 a day.
Medicaid cost sharing lives in a different universe. Federal rules cap a routine outpatient visit at $4 for enrollees at or below 100% FPL, preferred drugs at $4, non-preferred drugs and non-emergency ER use at $8, and an entire inpatient stay at $75. Every premium and copay a household pays combined is capped at 5% of family income. And states cannot charge anything at all for emergency services, family planning, pregnancy-related care, or preventive services for children. Nineteen states charge no Medicaid cost sharing on expansion adults whatsoever. See how much Medicaid costs for the full copay tables and the coming 2028 rule change.
One more asymmetry worth knowing: Medicare has no out-of-pocket maximum unless you buy a Medigap policy or join a Medicare Advantage plan. Medicaid’s 5% cap is built into federal law.
Dual Eligibility: About 12 Million People Have Both
Qualifying for Medicare does not disqualify you from Medicaid. KFF’s July 2026 analysis counts approximately 12 million dual-eligible individuals, who make up 21% of all Medicare beneficiaries and 13% of all Medicaid enrollees.
Of those, 8.6 million are full-benefit duals, meaning they get everything Medicaid covers that Medicare does not: long-term care, and in most states dental, vision, and non-emergency transportation. The other 3.5 million are partial-benefit duals who get help with Medicare premiums and, in many cases, cost sharing through the Medicare Savings Programs.
For duals, Medicare pays first and Medicaid wraps around it. That is the whole design.
QMB, SLMB, and QI
The Medicare Savings Programs are run by state Medicaid agencies, and they are the most under-claimed benefit in the system. Monthly income limits for 2026, from Medicare.gov, with a resource limit of $9,950 for an individual and $14,910 for a married couple across QMB, SLMB, and QI:
| Program | What it pays | 2026 income limit (individual) | 2026 income limit (couple) |
|---|---|---|---|
| QMB (Qualified Medicare Beneficiary) | Part A and B premiums, plus deductibles, coinsurance, and copayments | $1,350/mo | $1,824/mo |
| SLMB (Specified Low-Income Medicare Beneficiary) | Part B premium only | $1,616/mo | $2,184/mo |
| QI (Qualifying Individual) | Part B premium only; must reapply each year | $1,816/mo | $2,455/mo |
QMB is the strongest of the three. If you have it, Medicare providers are not allowed to bill you for deductibles, coinsurance, or copayments on covered services at all, though a small Medicaid copay may still apply. Enrolling in any of the three also automatically qualifies you for Extra Help, which caps your cost at $12.65 per covered drug in 2026.
Some states disregard certain income or resources and approve people above the federal numbers, so apply even if you think you are over. Our Medicare Savings Programs guide and Extra Help guide walk through the applications.
Where the Two Programs Diverge Most: Long-Term Care
If you take one practical point from this comparison, make it this one. Medicare does not pay for custodial long-term care, the help with bathing, dressing, and eating that most nursing home residents actually need. It covers a skilled nursing stay only after a qualifying hospital admission, and it stops entirely at day 100.
Medicaid is the country’s primary payer for long-term custodial care, which is why families who never expected to interact with Medicaid end up learning its asset rules. See does Medicare cover long-term care and does Medicaid pay for assisted living.
How to Apply
Medicare goes through the Social Security Administration. Your initial enrollment period runs seven months, starting three months before the month you turn 65. Missing it can trigger a permanent Part B late enrollment penalty.
Medicaid goes through your state Medicaid agency or through HealthCare.gov, which routes your application to the right state. There is no deadline, because Medicaid has no open enrollment period. If you are approved, coverage can be retroactive in many states. Once enrolled, the thing that most often costs people coverage is paperwork, so read up on Medicaid renewal before your redetermination notice arrives.
The Bottom Line
Medicare is age-and-disability coverage that costs $202.90 a month for Part B in 2026 and has no cap on what you can spend. Medicaid is income-based coverage that costs most enrollees close to nothing and caps total household cost sharing at 5% of income. They overlap for about 12 million people, and for that group the right move is to hold both and apply for a Medicare Savings Program.
If you fall between the two, with income too high for Medicaid in a non-expansion state and too young for Medicare, start with our guide for the uninsured and look into free and sliding-scale clinics, which price care against your income rather than a fee schedule.