While Medicare and Medicaid have similar-sounding names, they are actually two separate but related government-funded health insurance programs. They were established in 1965 to provide coverage for individuals who couldn’t afford to pay for health insurance out of pocket. Over the ensuing six decades, Medicare and Medicaid have expanded, but they remain distinct programs supporting different populations: older adults vs. low-income people of all ages.
Today, there are more than 76 million people (more than 7 million of whom are children) enrolled in Medicaid, while slightly fewer (about 69.7 million) are enrolled in Medicare, according to the . That means these public health insurance programs cover more Americans than any private insurance option does.
Understanding the differences between and Medicaid can help clarify who qualifies for which program and what they cover. Some individuals may also be eligible for both programs if certain criteria are met.
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At a Glance: Medicare vs. Medicaid 2026
Here’s how and Medicaid compare to one another in 2026.
| Feature | Original Medicare (Parts A and B) | Medicaid |
| Eligibility |
— Adults age 65 and older — Individuals with qualifying disabilities, including and |
Varies by state and is generally determined by:
— Income — Disability status — Dependent status — Pregnancy |
| Funding | Federal government | Jointly by federal and state governments |
| Primary coverage | Primary coverage source for dual-eligibles.
Covers: — Inpatient hospital care — — Emergency and diagnostic services — — Limited home healthcare services — Outpatient physician services — Preventive , vaccines and wellness visits — Some durable |
Secondary payer for dual-eligibles.
Covers: — Inpatient hospital care — Short-term care following hospitalization — Hospice care — Outpatient physician services — Preventive screenings, and wellness exams — Durable medical equipment — Emergency and diagnostic services — Maternity and newborn care — Children’s health — Long-term care in a — Some — Prescription drugs, dental care, vision services, and hearing aids, depending on the state plan |
| Out-of-pocket costs |
— $1,736 deductible for Part A (hospital services) in 2026 — Coinsurance for inpatient stays ranging from $0 to $868 in 2026, depending on length of stay; full cost for days 150 and beyond — Standard $202.90 monthly premium for Part B (outpatient medical services) in 2026 — Skilled nursing facility stay coinsurance of $0 to $217 per day, depending on length of stay; full cost for days 101 and beyond — Part D (prescription drug coverage) maximum $615 annual deductible — 25% coinsurance cost until you reach $2,100 out-of-pocket Part D spending limit |
Varies by state and service, but typically nominal amounts charged as:
— Limited — Enrollment fees — Copayments — Coinsurance — Deductibles — Other similar charges Out-of-pocket costs cannot be imposed on: — Emergency services — Family planning services — services — Preventive services for children |
| Long-term care | Doesn’t usually provide coverage for nursing home care | Covers care received in a nursing home |
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Medicare vs. Medicaid: Who Pays and Who Qualifies?
Both Medicare and Medicaid offer health care coverage, but they diverge when it comes to how they operate and who they cover:
— The Medicare framework: Administered at the federal government level, this program focuses primarily on age and criteria and operates uniformly across the U.S., regardless of a beneficiary’s income.
— The Medicaid framework: This state-administered assistance program is distributed in accordance with federal guidelines. It provides health insurance coverage to those with incomes below a specific amount, regardless of age, but its rules, thresholds and coverage options can vary based on where you live.
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Medicare Eligibility and Coverage
is generally determined by age, with potential beneficiaries encouraged to around their 65th birthday. In fact, you for not signing up for the program in a timely manner.
Medicare is overseen by the CMS, an agency of the federal government.
Medicaid Eligibility and Coverage
Medicaid primarily serves:
— Low-income individuals and families
—
— Children
— Disabled individuals, specifically older adults and younger people who receive Supplemental Security Income
Generally, individuals with income levels at or below 138% of the federal poverty level qualify for Medicaid. In 2026, this means that those who make less than $22,025 per year will qualify in most states, though Alaska and Hawaii have different qualifying thresholds. Some states apply different criteria to determine , such as whether the individual has children, is pregnant or has a disability.
What does Medicaid cover?
Medicaid generally covers:
— Inpatient care
— Outpatient care
—
— and
— Transportation to healthcare services
— Labs and X-ray services
These services can help people live better and longer despite being unable to afford medical care or having certain conditions, notes Martha Santana-Chin, CEO of L.A. Care Health Plan, the largest publicly operated health plan in the nation.
“Medicaid is one of the most cost-efficient forms of coverage, especially when compared to private insurance. Medicaid has lower administrative costs, lower out-of-pocket expenses for beneficiaries and slower cost growth per beneficiary,” Santana-Chin explains.
According to the CMS, patients with Medicaid usually pay none of the costs for covered medical expenses, or they may owe a small copayment. Since the enactment of the Affordable Care Act, states have been permitted to expand their Medicaid programs to cover all individuals with household incomes below a certain level. Some states have done so, while others have not. Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.
Beyond providing coverage, Medicaid also serves as a major funding source for safety net hospitals and other providers serving vulnerable populations, Santana-Chin adds.
Can I Have Both Medicare and Medicaid?
The short answer: Yes.
Approximately 20% of Medicare beneficiaries are eligible for both Medicare and Medicaid. These individuals are referred to as “dual eligibles,” and they qualify for benefits from both programs and lower out-of-pocket costs. also tend to be low-income seniors or people with disabilities, Santana-Chin notes.
“Being enrolled in both Medicare and Medicaid can lower your out-of-pocket costs substantially for those who qualify,” adds Whitney Stidom, vice president of consumer enablement with eHealth Inc., a health insurance broker and online resource provider headquartered in Indianapolis.
Which Special Needs Plans (SNPs) are available for dual eligibles?
Dual eligibles often have access to (SNPs), a type of Medicare Advantage program tailored for people with specific health needs. These plans include:
— Dual-Eligible SNPs, or D-SNPs, which “provide specialized care and wrap-around services for beneficiaries eligible for both Medicare and Medicaid,” Santana-Chin says.
— Chronic Condition SNPs, or C-SNPs, which offer additional services for beneficiaries with severe or chronic diseases, such as or .
— Institutional SNPs, or I-SNPs, which are designed for those needing .
Who pays first: Medicare or Medicaid?
In cases of dual-eligibility, Medicare acts as your primary insurer and Medicaid is your secondary payer, says Diane Omdahl, Wisconsin-based president and founder of 65 Incorporated, a Medicare consulting firm.
“(Medicaid) works like a supplement plan, picking up the costs that Medicare parts A and B don’t cover,” she explains.
However, Omdahl recommends consulting with a representative from your , known as SHIP, to ensure you’re getting the benefits you qualify for.
The “Dual Eligible” Tiers Table
Some dual-eligible beneficiaries may qualify for assistance to pay Medicare premiums through a . These plans aim to help low-income individuals save money on the out-of-pocket expenses associated with Medicare. Each program has a different income and resource eligibility limit. Here’s how they compare to one another.
2026 Medicare Savings Program income and resource limits
| MSP type | Who’s it for? | What does it do? | Monthly federal income limits | Federal asset limits |
| Qualified Medicare Beneficiary (QMB) | People whose income is less than 100% of the federal poverty level (FPL) | Covers Medicare premiums, deductibles, copayments and/or coinsurance | $1,350 individual or $1,824 married couple (Alaska and Hawaii limits are higher) | $9,950 individual or $14,910 married couple |
| Specified Low-Income Medicare Beneficiary (SLMB) | Older adults and adults with disabilities who have income between 100% and 120% of the FPL; must have original Medicare (parts A and B) to qualify | Covers Medicare Part B premium ($202.90 in 2026) | $1,616 individual or $2,184 married couple (Alaska and Hawaii limits are higher) | $9,950 individual or $14,910 married couple |
| Qualifying Individual (QI) | Limited program for people with income between 120% and 135% of FPL who also meet resource requirements; must have original Medicare to qualify | Covers Medicare Part B premiums ($202.90 in 2026) | $1,816 individual or $2,455 married couple (Alaska and Hawaii income limits are higher) | $9,950 individual or $14,910 married couple |
| Qualified Disabled and Working Individual (QDWI) | Adults under age 65 with disabilities but have recently returned to work and lost their eligibility for premium-free Part A; income must be below 200% of the FPL | Covers Medicare Part A premium | $5,405 individual or $7,299 married couple (Alaska and Hawaii income limits are higher) | $4,000 individual or $6,000 married couple |
Source:
If you’re enrolled in one of these programs, you automatically qualify to receive the Low-Income Subsidy Extra Help program, which helps .
What’s New for 2026: Integrated Care and D-SNPs
The CMS Final Rule for 2026 introduces major shifts in coverage and systems, particularly a push for streamlined services for the nearly 13 million people who are dually eligible for Medicare and Medicaid. Key changes include:
— The move to integrated D-SNPs: CMS is phasing out D-SNP look-alikes and combining Medicare and Medicaid benefits into a single plan with one care team. Integrated plans will also have increased care coordination and technology solutions, such as unified appeals and grievance systems to improve navigating coverage disputes.
— One card, one plan: By January 1, 2027, D-SNPs must issue a single member identification card that works for both Medicare and Medicaid.
— Unified health risk assessments (HRAs): Instead of separate paperwork, plans will also be required to conduct an integrated HRA for both Medicare and Medicaid. To be in compliance, HRAs must be completed within 90 days of enrollment and renewed annually, within 365 days of the previous assessments. Individual care plans must be completed within 30 days of the initial HRA or 30 days after enrollment, whichever comes later.
— New enrollment windows: Dual-eligibles with full Medicaid benefits will have access to a monthly special enrollment period to switch to an integrated D-SNP.
— Financial caps: The update includes a standardized $2,100 out-of-pocket maximum for .
Medicaid Income Limits 2026
Each year, the Department of Health and Human Services sets a national federal poverty level that’s used to determine eligibility for certain programs and benefits, including Medicaid and the Children’s Health Insurance Program — a joint federal-state program that provides coverage for children and pregnant women who may earn too much to qualify for Medicaid. In 2026, people who fall under 138% of the FPL typically qualify for Medicaid.
| Family/household size | FPL 2026 annual income | 138% FPL in 2026 |
| Individual | $15,960 | $22,025 |
| Family of 2 | $21,640 | $29,863 |
| Family of 3 | $27,320 | $37,702 |
| Family of 4 | $33,000 | $45,540 |
| Family of 5 | $38,680 | $53,378 |
| Family of 6 | $44,360 | $61,217 |
| Family of 7 | $50,040 | $69,055 |
| Family of 8 | $55,720 | $76,894 |
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Medicaid and Medicare Coverage Challenges Ahead
Recent federal legislative efforts have altered the landscape for both Medicare and , which could impact individuals enrolled in Medicare, Medicaid or both in the coming years.
“Medicaid is due for a shake-up following passage of the Big Beautiful Bill,” Stidom notes, referring to the One Big Beautiful Bill Act signed into law in July 2025.
These changes may include:
— Difficulty with qualifying: “Fewer federal dollars will be going to the states for Medicaid support, and it may be harder for some people to qualify for Medicaid under new rules,” Stidom explains. “As a result, millions of Medicaid beneficiaries could potentially lose their coverage.” These changes may impact dual-eligible individuals and also lead to higher out-of-pocket costs under Medicare, she adds.
— Loss of coverage: Some Medicaid beneficiaries who are not enrolled in Medicare could also lose their coverage, Stidom points out, but there may be another option — accessing other coverage options under the Affordable Care Act. For example, if you earn no more than 400% of the federal poverty level ($63,840 in 2026 for an individual), you may qualify for subsidy assistance that makes health insurance premiums much more affordable when buying coverage on your .
You’ll have an opportunity to for 2027 beginning on October 15 when the annual open enrollment period opens. This period runs through December 7. You should also watch for communications from your current plan to understand how your coverage may change next year.
A licensed health insurance can help you review options from multiple insurers to find the best match for your needs and budget, as this can result in significant savings depending on your situation.
Update 06/10/26: This story was published at an earlier date and has been updated with new information.
