The core differences
| Medicare | Medicaid | |
|---|---|---|
| Run by | Federal government (CMS) | States, with federal funding |
| Who qualifies | Age 65+, or under 65 with long-term disability, ESRD, or ALS | People with limited income and resources; rules vary by state |
| Premiums | Part B premium ($202.90 in 2026); Part A usually $0 | Usually little or none |
| Long-term nursing home care | Short-term skilled care only | Covers long-term care if you qualify |
| How to apply | Social Security (ssa.gov or 1-800-772-1213) | Your state Medicaid agency |
If you have both: "dual eligible"
People with both programs are called dual eligible. Medicare pays first for services it covers, and Medicaid may pay the rest, such as premiums, deductibles, coinsurance, and services Medicare does not cover, like long-term care. Many dual-eligible people also qualify for Extra Help with drug costs.
Help for people who are close to the limit
You may not qualify for full Medicaid but still get help through a Medicare Savings Program, which can pay your Part B premium and, for QMB, your deductibles and coinsurance too.
Which should you use for nursing home care?
Medicare covers up to 100 days of skilled nursing care after a qualifying hospital stay, with a daily charge after day 20 ($217 in 2026). Long-term custodial care is generally paid by Medicaid (if you qualify), long-term care insurance, or personal funds. See the nursing home guide.