Can I have Medicaid and Medicare at the same time?

Yes. Dual eligibles have Medicare as primary coverage and Medicaid covering premiums, cost-sharing and extra services.

Does Medicaid replace Medicare?

No. If you are eligible for Medicare you must enroll; Medicaid then pays second.

Which is better, Medicaid or Medicare?

They are not substitutes. Having both gives the broadest coverage with the lowest out-of-pocket cost.

Guide · August 22, 2026

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

People mix these up constantly, and the confusion costs money. Medicare is federal health insurance you earn through work, available at 65 or after two years on disability benefits, regardless of income. Medicaid is a joint federal-state program for people with limited income and, for some groups, limited assets. You can qualify for one, the other, or both.

Side by side

	Medicare	Medicaid
Who runs it	Federal government (CMS)	Each state, with federal funding
Who qualifies	Age 65+, or under 65 with SSDI for 24 months, ESRD, or ALS	Low-income adults, children, pregnant women, seniors and people with disabilities
Income test	None (higher earners pay higher premiums)	Yes, as a percentage of the federal poverty level
Asset test	None	Yes for seniors and disabled applicants in most states
Premiums	Part B about $185/month in 2025; Part A usually free	Usually none
Long-term care	Up to 100 days of skilled nursing after a hospital stay	Covers nursing home and in-home care indefinitely for those who qualify

Dual eligibility: having both

Roughly one in five Medicare beneficiaries also has Medicaid. When you have both, Medicare pays first and Medicaid picks up most of what is left: premiums, deductibles, copays, and services Medicare does not cover such as dental, vision and long-term care. Most dual-eligibles pay nothing out of pocket for covered care.

Partial help: Medicare Savings Programs

If your income is too high for full Medicaid but still modest, your state Medicaid agency runs three programs that pay Medicare costs: QMB (pays the Part B premium and all cost-sharing), SLMB and QI (pay the Part B premium only). Enrolling in any of them also qualifies you automatically for Extra Help with prescription drug costs. Limits are on each state's Medicare Savings Programs page on this site.

What to do next

If you are 65+ or on SSDI, check the Medicare Savings Program limits for your state.
Apply through your state Medicaid agency, not through Medicare.
If approved for QMB, show both cards at every visit; providers cannot bill you for Medicare cost-sharing.