{"id":355758,"date":"2016-04-04T10:45:23","date_gmt":"2016-04-04T15:45:23","guid":{"rendered":"https:\/\/ability-fl-prod.internetbrands.com\/ability-law\/elder\/elder-care-law\/medicare-vs-medicaid.html"},"modified":"2026-08-05T11:21:00","modified_gmt":"2026-08-05T16:21:00","slug":"medicare-vs-medicaid","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/elder\/elder-care-law\/medicare-vs-medicaid.html","title":{"rendered":"Medicare vs. Medicaid for Older Adults"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n<div class=\"fl-page-articles fl-section-main fl-section-main-full-width\"><h1 class=\"fl-no-margin-top\">Medicare vs. Medicaid for Older Adults<\/h1>\n\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/olivia-wathne-jd\/\">Olivia Wathne, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/melissa-bender-esq\/\">Melissa Bender, Esq.<\/a>\n                | Last updated\n        <time>\n                            August 05, 2026\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n\n\n<div class=\"fl-key-takeaways fl-mb30\" data-testid=\"fl-key-takeaways\">\n    <div class=\"fl-card-content\">\n        <div class=\"fl-card-body fl-card-bg-teal fl-flex fl-flex-column\">\n                            <h2 class=\"fl-card-title fl-h2 fl-no-margin\">Key Takeaways<\/h2>\n                        <p>Medicare is an earned federal insurance program for adults 65+ and certain younger people with <span data-term-id=\"59625671\">disabilities<\/span>, offering standardized coverage nationwide. <span data-term-id=\"59625670\">Medicaid<\/span> is a state\u2011run assistance program that helps low\u2011income individuals of any age access essential and long\u2011term care services. Some older adults qualify for both, allowing <span data-term-id=\"59625670\">Medicaid<\/span> to fill cost and coverage gaps that Medicare doesn\u2019t address.<\/p>\n\n        <\/div>\n    <\/div>\n<\/div>\n\n\n<p>Medicare and Medicaid are government-sponsored programs to help people pay for health care costs. While both programs are taxpayer-funded, they have different eligibility requirements and costs. Your loved one may qualify for Medicare and Medicaid. But they must meet separate eligibility requirements for each program.<\/p>\n<p>If you are a caregiver, knowing the eligibility requirements and cost differences between these two programs can significantly affect the health care options available to your loved one. Keep reading to learn more. At the end of the article, you&#8217;ll find a table comparing key aspects of Medicare and Medicaid at a glance.<\/p>\n<hr \/>\n<p>Navigating an older loved one&#8217;s financial and long-term care planning can be overwhelming and confusing. But legal help is available. An <a href=\"https:\/\/lawyers.findlaw.com\/\" target=\"_blank\" rel=\"noopener\">estate planning attorney near you<\/a> can explain eligibility, protect assets, and help coordinate long\u2011term care options that best serve your loved one.<\/p>\n<hr \/>\n<h2>Medicare Coverage 101<\/h2>\n<p>Medicare is\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare-an-overview.html\">an insurance enrollment program<\/a>\u00a0attached to Social Security. We pay for it by paying into Social Security. It was created to address the high medical costs older people face relative to the rest of the population. You can also use Medicare Advantage Plans through private insurance companies.<\/p>\n<p>Medicare is available to people 65 or older, whatever their income, younger disabled people, and dialysis patients. The federal government administers it and generally operates the same everywhere in the United States.<\/p>\n<p>The four-part Medicare program includes:<\/p>\n<ul>\n<li><b>Part A.<\/b>\u00a0Hospitalization coverage provides basic coverage for inpatient hospital visits, nursing facility visits, and home health care.<\/li>\n<li><b>Part B.<\/b>\u00a0Medical insurance pays most doctor and lab costs and some outpatient medical services. That includes supplies and equipment, home health care, and physical therapy.<\/li>\n<li><b>Part C.\u00a0<\/b>Privately purchased supplemental insurance provides more services.<\/li>\n<li><b>Part D.\u00a0<\/b>Prescription drug coverage pays some of the costs of prescription medications.<\/li>\n<\/ul>\n<h2>Paying for Medicare Costs<\/h2>\n<p>You generally don&#8217;t have to pay a\u00a0<a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/what-does-medicare-cost\" target=\"_blank\" rel=\"noopener\">monthly premium for Part A<\/a>\u00a0coverage if you or your spouse paid Medicare taxes while working.<\/p>\n<p>If you buy Part A, you&#8217;ll pay a monthly premium ($311 or $565 each month in 2026). But you can get premium\u2011free Part A at 65 if any of the following apply:<\/p>\n<ul>\n<li>You already get retirement benefits from Social Security<\/li>\n<li>You&#8217;re eligible to get Social Security<\/li>\n<li>You or your spouse had Medicare-covered government employment<\/li>\n<\/ul>\n<p>Also, most people pay the Part B premium ($202.90 each month in 2026). Individuals must also pay $283 per year as their Part B deductible.<\/p>\n<p>Finally, under Part D, you&#8217;ll pay a premium, yearly deductible, copayments or <a href=\"https:\/\/www.findlaw.com\/consumer\/insurance\/insurance-policies.html\">coinsurance<\/a>, and other costs.<\/p>\n<h2>Medicaid Coverage Basics<\/h2>\n<p>The Medicaid program is\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicaid.html\">an assistance program<\/a>\u00a0paid for by taxpayers. Medicaid is available to low-income people of all ages who fit into an eligibility group recognized under federal or state law.<\/p>\n<p>Beneficiaries must have an income level at or below the federal poverty level. Eligible users can get health coverage from various healthcare providers through their Medicaid benefits. Cost-sharing payment plans or full payment coverage pay for it.<\/p>\n<p>States and local governments administer Medicaid within federal guidelines. The nuances and rules can vary from state to state. Services differ, but the government mandates coverage for certain services when they are &#8220;medically necessary.&#8221;<\/p>\n<p>These covered services generally include:<\/p>\n<ul>\n<li>Hospitalization<\/li>\n<li>Doctor visits and basic services<\/li>\n<li>Family planning<\/li>\n<li>Laboratory services<\/li>\n<li>Nursing services<\/li>\n<li>Medical and surgical dental services<\/li>\n<li>X-rays<\/li>\n<li>Nursing homes and inpatient nursing facility services<\/li>\n<li>Home health care for people eligible for nursing facility services<\/li>\n<li>Clinic treatment<\/li>\n<li>Pediatric and family nurse practitioner services<\/li>\n<li>Midwife services<\/li>\n<li>Screening, diagnosis, and treatment services for people under 21<\/li>\n<\/ul>\n<p>States have the option of including more benefits, such as:<\/p>\n<ul>\n<li>Prescription drug coverage<\/li>\n<li>Optometrist services<\/li>\n<li>Medical transportation services<\/li>\n<li>Physical therapy<\/li>\n<li>Prosthetic services<\/li>\n<li>Dental services<\/li>\n<\/ul>\n<p>Depending on your particular state, you may have to pay:<\/p>\n<ul>\n<li>Copayments<\/li>\n<li>Coinsurance<\/li>\n<li>Deductibles<\/li>\n<li>Similar charges<\/li>\n<\/ul>\n<p>But out-of-pocket costs are limited and typically only apply to groups of people with higher incomes.<\/p>\n<h2>Dual Eligibility for Medicare and Medicaid<\/h2>\n<p>The\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/obamacare-basics-understanding-the-affordable-care-act.html\">Affordable Care Act<\/a>\u00a0created the Medicare-Medicaid Coordination Office under the\u00a0<a href=\"https:\/\/www.cms.gov\/\" target=\"_blank\" rel=\"noopener\">Centers for Medicare &amp; Medicaid Services<\/a>. This office coordinates care for dual-eligible people.<\/p>\n<p>People who qualify for Medicare and Medicaid are &#8220;dual eligible.&#8221; If you qualify and enroll in both programs, the two can coordinate to cover your health care costs.<\/p>\n<p>For example, Jane is a 72-year-old woman who has been living with a disability and requires help with activities of daily living, such as dressing, bathing, and eating. She has limited income and assets. In this situation:<\/p>\n<ul>\n<li><b>Medicare eligibility.<\/b>\u00a0Jane is eligible for Medicare because she is over 65. She is enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). They cover certain hospital and medical services.<\/li>\n<li><b>Medicaid eligibility.<\/b>\u00a0Due to her limited income and assets, Jane also qualifies for Medicaid. It provides coverage for a broader range of health care services. They include long-term care services that Medicare does not fully cover.<\/li>\n<li><b>Dual eligibility benefits.<\/b>\u00a0With dual eligibility, Jane gets benefits from Medicare and Medicaid. This means that Medicare covers certain medical services, while Medicaid helps cover long-term care costs. That includes nursing home care, home-based care, and other services that support her daily living needs.<\/li>\n<\/ul>\n<p>In this scenario, dual eligibility allows Jane to access a more comprehensive range of health care services. This ensures her medical and long-term care needs get addressed. Medicaid helps <a href=\"https:\/\/www.webmd.com\/health-insurance\/features\/medicare-rx-benefit-sorting-out-options\" target=\"_blank\" rel=\"noopener\">fill the gap<\/a>s in coverage that Medicare doesn&#8217;t provide. This is especially true for services needed for chronic illnesses or disabilities.<\/p>\n<h2>Long-Term Care and Other Considerations: Getting Legal Help<\/h2>\n<p>Medicaid is the largest source of long-term care funding. But long-term care isn&#8217;t covered by Medicare or, often, by private health insurance policies.<\/p>\n<p>As a result, many patients rely on Medicaid to help pay for their long-term care. Because Medicaid requires recipients to have virtually no assets, many attorneys specialize in helping people divest their assets to qualify for Medicaid and get long-term care.<\/p>\n<p>You may have questions about the eligibility requirements for Medicare and Medicaid, the benefits involved, or any other issues related to the two programs. It&#8217;s in your best interests to\u00a0<a href=\"https:\/\/www.findlaw.com\/elder\/what-is-elder-law\/what-does-an-elder-law-attorney-do.html\">contact an elder law attorney<\/a>. They can give you legal advice on issues ranging from estate planning and asset protection to Medicare and Medicaid planning.<\/p>\n<p>FindLaw\u2019s\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/elder-law\/\" target=\"_blank\" rel=\"noopener\">directory of elder law attorneys<\/a> can get you started. Enter your city or ZIP code for a list of qualified legal professionals near you. Because your state\u2019s laws are relevant, your attorney should be licensed in your state. Your search results will also show important details about prospective attorneys, like ratings and whether they offer free case evaluations.\u00a0<\/p>\n<h2>Medicare vs. Medicaid: A Comparison<\/h2>\n<p>The following table contains a clear breakdown of the key differences between Medicare and Medicaid.<\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"10\">\n<tbody>\n<tr>\n<td valign=\"top\">\n\n<\/td>\n<td valign=\"top\">\n<p><b>Medicaid<\/b><\/p>\n<\/td>\n<td valign=\"top\">\n<p><b>Medicare<\/b><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p><b>Who Runs It<\/b><\/p>\n<\/td>\n<td valign=\"top\">\n<p>Medicaid is a federal program administered by the states. Information is available at your state\u2019s health services office.<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Medicare is a federal program with uniform, national rules.<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p><b>Eligibility<\/b><\/p>\n<\/td>\n<td valign=\"top\">\n<p>Low-income people are\u00a0<a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility\/index.html\" target=\"_blank\" rel=\"noopener\">eligible for Medicaid<\/a>, regardless of age.<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Medicare benefits can begin as early as age 62, or even earlier in the case of serious disability covered by Social Security.<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p><b>Coverage<\/b><\/p>\n<\/td>\n<td valign=\"top\">\n<p>Medicaid covers basic health care costs such as visits to the doctor and hospital stays, but can also cover things like the cost of eyeglasses.<\/p>\n<p>Medicaid also\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicaid-for-nursing-home-for-spouse-if-i-can-still-live-independ.html\" target=\"_blank\" rel=\"noopener\">pays for nursing home care<\/a>\u00a0for those in need.<\/p>\n<\/td>\n<td valign=\"top\">\n<p><a href=\"https:\/\/www.medicare.gov\/what-medicare-covers\/part-a\/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Part A<\/a>: Hospital and post-hospital facility charges, as well as home health care.<\/p>\n<p><a href=\"https:\/\/www.medicare.gov\/what-medicare-covers\/part-b\/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Part B<\/a>: Doctor fees and lab costs, outpatient care (can include physical therapy and medical equipment )<\/p>\n<p><a href=\"https:\/\/medicare.com\/medicare-advantage\/medicare-part-c\/\" target=\"_blank\" rel=\"noopener\">Part C<\/a>\u00a0(Medicare Advantage): Provided through private insurers; coverage varies by provider.<\/p>\n<p><a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/choosing-a-medicare-part-d-plan.html\" target=\"_blank\" rel=\"noopener\">Part D<\/a>: Prescription drug coverage.<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p><b>Costs<\/b><\/p>\n<\/td>\n<td valign=\"top\">\n<p>Medicaid\u00a0<a href=\"https:\/\/www.medicaid.gov\/medicaid\/cost-sharing\/out-of-pocket-costs\/index.html\" target=\"_blank\" rel=\"noopener\">sometimes charges its users small fees<\/a>\u00a0for certain services.<\/p>\n<p>Medicaid will often pay for Medicare deductibles and premiums, and it can cover the 20% of medical costs that Medicare will not pay for.<\/p>\n<\/td>\n<td valign=\"top\">\n<p>There is a yearly deductible for all three Medicare plans.<\/p>\n<p>Part A: Copayments for lengthy hospitalizations.<\/p>\n<p>Part B: 20% to 35% of medical bills, plus a monthly premium.<\/p>\n<p>Part C (Medicare Advantage): Costs for\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare-managed-care.html\" target=\"_blank\" rel=\"noopener\">Medicare Advantage<\/a>\u00a0vary by provider.<\/p>\n<p>Part D: The former coverage gap (\u201cdonut hole\u201d) has been closed, and in 2026 Medicare Part D includes a $2,000 annual cap on out\u2011of\u2011pocket prescription drug costs. Plans may still have premiums, deductibles, and cost\u2011sharing, but beneficiaries will not pay more than $2,000 total for covered medications.<\/p>\n<p>Beneficiaries must also pay a monthly premium and 25% of drug costs once the deductible is met.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg 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          >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--missing-info\"\n                        >Missing the information I need<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--complicated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Too complicated\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--complicated\"\n                        >Too complicated \/ too many steps<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--dated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Out of date\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--dated\"\n                        >Out of date<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex 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