Navigating healthcare can feel like a maze, especially when you’re trying to distinguish between programs with such similar names. The primary difference between Medicaid and Medicare is who they serve. Medicare is generally based on age—specifically those 65 and older—or certain disabilities, while Medicaid is a state-administered program designed for those with low income and limited resources.
While Medicare has standard federal costs, such as premiums and deductibles, Medicaid often covers these out-of-pocket expenses for eligible beneficiaries. If you meet the criteria for both, you’re considered dual eligible, meaning you can use both programs together to maximize your healthcare coverage and minimize your costs.
Medicare and Medicaid: Comparing the Two Programs
Because these programs are often mentioned in the same breath, it’s helpful to look at them side by side. Understanding the differences will help you feel confident in knowing which program (or combination) fits your current situation.
Medicare vs. Medicaid Comparison Table
Feature | Medicare | Medicaid |
Who It's For | Adults 65+, or those with certain disabilities or ESRD (early-stage renal disease) | Individuals and families with limited income and resources |
Funding | Federal government | Jointly funded by federal and state governments |
Administration | Consistent rules nationwide | Managed by individual states (rules vary by location) |
Costs | Premiums, deductibles, and coinsurance usually apply | Very low or no cost for those who qualify |
Long-Term Care | Limited coverage (mostly skilled nursing) | Extensive coverage for nursing homes and home health care |
Federally Funded vs. State-Funded Healthcare Programs
The reason these programs might feel different as you use them has to do with who is ultimately in control of the program. Medicare is a federal program, meaning your Medicare Part A and Part B benefits will be largely the same whether you live in Florida or Washington.
Medicaid, however, is a partnership between the federal and state governments. While the federal government sets the baseline, each state manages its own program. This is why you’ll notice that Medicaid eligibility and specific benefits can change if you move across state lines. This is important to understand, particularly if there has been, or may be, a move in your personal situation. Understanding these local nuances is key to making sure your coverage matches your specific ZIP code.
Coverage and Costs: Is Medicaid free for seniors?
A common question we hear is whether Medicaid provides "free" healthcare. For seniors who qualify, Medicaid acts as a safety net that covers many of the costs Medicare leaves behind.
While Original Medicare typically requires you to pay monthly premiums (especially for Part B) and a 20% coinsurance for most medical services, Medicaid can often step in to pay those premiums and eliminate out-of-pocket costs. For those with very limited income, Medicaid can make healthcare virtually free; however, specific "spend-down" programs or small copays may apply depending on your state’s rules.
Dual Eligible Medicare Medicaid Plans
If you qualify for both programs, you don't have to choose just one. Being dual eligible allows you to enjoy the broad Medicare network while receiving the financial protections of Medicaid. You can find more details on how this works on our dual eligibility page.
How Medicare and Medicaid Work Together for Dual Eligibles
When you have both, the two programs work in a specific order—often called "coordination of benefits."
Primary Payer: Medicare always pays first for covered medical services.
Secondary Payer: Medicaid steps in second to cover the remaining "gaps," such as your Part B deductible or the 20% you would normally owe for a doctor’s visit.
Medicare Advantage and Special Needs Plans
Many dual-eligible individuals choose to receive their benefits through a private Medicare Advantage plan. Specifically, a Dual-Eligible Special Needs plan (D-SNP) is designed to coordinate your Medicare and Medicaid benefits into one simple plan. These often include extra benefits that Original Medicare doesn’t offer—like dental, vision, or even allowances for healthy groceries and utilities.
Frequently Asked Questions About 2026 Coverage Transitions
Staying informed is the best way to ensure your healthcare remains both affordable and effective. As we move through 2026, several significant updates are taking effect—including the first set of Medicare-negotiated drug prices and a new out-of-pocket cap for Part D prescription drugs. Whether you're navigating the standard Part B premium increase or monitoring state-specific Medicaid work requirements, understanding these shifts helps you avoid surprises. Below, we address the most common questions our seasoned agents hear regarding this year's changes.
Can I lose Medicaid and keep Medicare in 2026?
Yes. It’s possible to lose Medicaid eligibility if your income or asset levels change, but this doesn't automatically impact your Medicare status. If you lose Medicaid, you'll still have your Medicare coverage, but you may become responsible for premiums and copays you didn’t have to pay before. We recommend a plan review if your financial situation changes to ensure you aren't overpaying.
Does Medicaid pay for 2026 Medicare Part B premiums?
For most dual-eligible individuals, yes. Through Medicare Savings Programs (MSPs), your state’s Medicaid program can pay your monthly Part B premiums. As we move through 2026, it’s important to stay updated on your state’s income thresholds, which are adjusted annually. With the standard Part B premium rising to $202.90 this year, ensuring your MSP status is active is more important than ever.
How SelectQuote Can Support You
Choosing between plans shouldn't feel like a burden. We’re here to be a trusted partner and advocate for you, leveraging decades of experience to simplify the process.
How Licensed Agents Help Compare Dual-Eligible Plans
Our licensed insurance agents are commission-agnostic—meaning they're focused on your best interests, not which policy pays them the most commission. We use our proprietary technology to scan the market, comparing D-SNPs and other Medicare Advantage options to find the specific coverage that fits your budget and healthcare needs.
Requesting a Plan Review
Whether you’re curious about the difference between Medicare and Medicaid or you think you might be dual eligible, we can help. Our agents can provide a free plan review, taking the time to get to know you and your unique situation.
