Medicare vs. Medicaid: what’s the difference, and can you have both?
The short answer
Medicare is federal health insurance you get because of your age or a disability. Medicaid is a program run by your state, under federal rules, for people with limited income and resources. They are not the same thing — and many people qualify for both. When you have both, Medicare pays first and Medicaid pays last.
The two names are one letter apart, and I hear them mixed up every week — sometimes by the person the coverage is for, and often by the son or daughter helping a parent with the paperwork. The mix-up matters, because the two programs have different rules, different offices and different ways to sign up.
Here is how they differ, how they fit together, and what to do in Washington, Texas or Nevada.
The difference, side by side
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | The federal government | Your state, following federal rules |
| Who it is for | People 65 and older, and some younger people with certain disabilities or conditions | Certain people with limited income and resources — including families and children, pregnant women, older adults and people with disabilities |
| What decides it | Mainly your age or a disability | Mainly your income and resources, under your state’s rules |
| When you can apply | During set enrollment periods | Any time of year |
| What it is called here | Medicare, in every state | Apple Health in Washington; Texas Medicaid; Nevada Medicaid |
Medicare, in plain words
Medicare is federal health insurance for anyone 65 and older, and for some people under 65 with certain disabilities or conditions. It comes in parts: Part A helps cover hospital stays, skilled nursing facility care, hospice and some home health care. Part B helps cover doctors, outpatient care, medical equipment and many preventive services. Part D helps cover prescription drugs.
You get those benefits one of two ways: through Original Medicare (Parts A and B, often with a separate drug plan and supplemental coverage), or through a Medicare Advantage plan, which is a private plan that bundles Parts A and B and usually drug coverage. That choice is the conversation most of my Medicare clients start with — how I help with Medicare.
Medicaid, in plain words
Medicaid is a joint federal and state program that helps with medical costs for certain people with limited income and resources. Because each state runs its own program, who qualifies and what it covers differ from state to state. Medicaid also covers things Medicare usually does not, such as nursing home care and personal care services.
Two things surprise people. You can apply for Medicaid any time of year — there is no enrollment window. And Medicaid may be able to help pay for medical care from the last three months, even if you were not enrolled when you got the care.
Washington, Texas and Nevada are not the same
- Washington: Medicaid is called Apple Health, run by the Health Care Authority. Adults 19 to 64 who do not have Medicare can qualify with income at or below 138% of the federal poverty level.
- Texas: Texas Medicaid is run by Texas Health and Human Services. For adults, it is built around specific groups — parents and caretakers of children who have Medicaid, pregnant women, people with disabilities, and people 65 and older — rather than income alone.
- Nevada: you apply through the Division of Welfare and Supportive Services, online at Access Nevada.
Can you have both? Yes — it is called being dual eligible
If you have Medicare and also qualify for full Medicaid, you are what the programs call dually eligible. The two work as a team, in a set order:
- Medicare pays first for Medicare-covered services. Medicaid pays last, after Medicare and any other insurance you have.
- Your state pays your Part B premium, and depending on your level of Medicaid it may also pay your Medicare deductibles, coinsurance, copays and Part A premium.
- Your prescriptions move to Medicare drug coverage. You are enrolled in a Medicare drug plan automatically, and you get Extra Help with drug costs automatically.
- Medicaid may still pay for some drugs and services that Medicare does not cover.
Not everyone who is short on money qualifies for full Medicaid. If your income is a little too high, a Medicare Savings Program may still pay your Part B premium — and the rules for it are more generous than most people expect. I wrote a separate guide on that: who qualifies for a Medicare Savings Program.
Where does Obamacare fit?
Obamacare is the common name for the Health Insurance Marketplace — private health plans that people buy for themselves, sometimes with help paying for them. It is not Medicaid, and it is not Medicare.
Once you have Medicare, the Marketplace is generally not for you. It is against the law for someone who knows you have Medicare to sell you a Marketplace plan. And if you already have a Marketplace plan when Medicare starts, it does not end on its own — you have to end it, so you are not paying for coverage you no longer use. If you are under 65 and do not have Medicare, individual and family health coverage is where I would start.
Where I come in
Medicaid applications go to your state, and the state decides. What I do is the Medicare side: help you understand your choices, check your doctors and prescriptions, and make sure your coverage fits once Medicaid or a savings program is approved. If you are not sure which office to call, I will point you to the right one. There is no cost for my help, and I work by phone or video, in English or Spanish.
Questions people ask
Is Medicare the same as Medicaid?
No. Medicare is federal health insurance for people 65 and older and some younger people with disabilities. Medicaid is a program your state runs, under federal rules, for people with limited income and resources.
Can I have Medicare and Medicaid at the same time?
Yes. People who have Medicare and full Medicaid are called dually eligible. Medicare pays first for Medicare-covered services and Medicaid pays last.
If I have both, who pays my Part B premium?
If you qualify for full Medicaid, your state pays your Medicare Part B premium. Depending on your level of Medicaid, it may also pay your deductibles, coinsurance and copays.
Is Obamacare the same as Medicaid?
No. Obamacare is the common name for the Health Insurance Marketplace, where people buy private health plans. Medicaid is a state program for people with limited income and resources.
When can I apply for Medicaid?
Any time of year. Medicare has set enrollment periods, but Medicaid does not.
Sources
- Medicare.gov — What’s Medicare?
- Medicare.gov — Medicaid
- Medicare.gov — Medicare Savings Programs (2026 limits)
- Washington Health Care Authority — Apple Health for adults (WAC 182-505-0250)
- Texas HHS — Medicaid for parents and caretakers
- Texas HHS — Medicaid for the elderly and people with disabilities
- Nevada DWSS — Access Nevada
- HealthCare.gov — Medicare and the Marketplace
- HealthCare.gov — Medicaid & CHIP coverage
Figures are the ones the source published for the year shown. Programs update their limits every year — if you are reading this later, check the source or call me.
More guides
Helping a parent sort this out?
Ten minutes on the phone usually tells us which program to look at first. English or Spanish, and there is no cost for my help.