Medicare and Medicaid are not the same program. Medicare is federal health insurance for people 65 and older and for some younger people with disabilities, whatever their income. Medicaid is health coverage for people with low income, run by each state with federal money. Some people qualify for both, and then the two programs work together.
The names sound alike because both were signed into law in 1965. Still, they answer different questions. Medicare asks how old you are or whether you have a qualifying disability. Medicaid asks how much you earn and, for some groups, what you own.
Medicare vs. Medicaid at a glance
The table below sets out the main differences. Dollar figures are for 2026.
| Medicare | Medicaid (Medi-Cal in California) | |
|---|---|---|
| Who it is for | People 65+, plus some younger people with disabilities, ESRD or ALS | People with limited income and, for some groups, limited assets |
| Who runs it | Federal government (Centers for Medicare & Medicaid Services) | Each state, under federal rules |
| Who pays for it | Payroll taxes, federal funds and enrollee premiums | Federal and state governments together |
| Income test | No | Yes |
| Typical cost to you | Part B premium $202.90 a month; deductibles and coinsurance | Little or nothing; small copays in some states |
| Long-term nursing home care | Not covered beyond short skilled-nursing stays | Covered if you qualify |
| When you can enroll | Set enrollment periods, starting around age 65 | Any time of year |
Who qualifies for each
Medicare eligibility is mostly about age. You can usually join at 65 if you or your spouse paid into Social Security or Railroad Retirement. Younger people qualify after 24 months of Social Security disability benefits. People with end-stage renal disease (permanent kidney failure) or ALS can also qualify earlier. Income does not matter, so a retired executive and a retired cashier get the same Medicare.
Medicaid eligibility depends on income first. In states that expanded Medicaid under the Affordable Care Act, most adults under 65 qualify with income up to 138% of the federal poverty level. California is one of those states. Children, pregnant people, older adults and people with disabilities have their own groups and limits. Because each state sets many of its own rules, two people with the same income can get different answers in different states.
Timing differs too. Medicare has a seven-month Initial Enrollment Period around your 65th birthday, and signing up late for Part B can mean a lasting penalty. Medicaid, however, takes applications all year, so you can apply the month your income drops.
Who runs and pays for each program
Medicare is one national program. The federal Centers for Medicare & Medicaid Services (CMS) sets the rules, and the benefits are the same in every state. Part A is funded mainly by payroll taxes. Part B and Part D are funded by general federal revenue plus the premiums enrollees pay.
Medicaid is a partnership. The federal government sets minimum rules and pays a large share of the bill. Each state then designs its own program, adds optional benefits and chooses its own name. That is why the program is called Medi-Cal in California, while in other states the name is something else entirely. You can see the federal framework on Medicaid.gov.
What each program covers
Medicare comes in parts. Part A covers hospital stays, short stays in a skilled nursing facility, hospice and some home health care. Part B covers doctor visits, outpatient care, lab tests and medical equipment. Part D covers prescription drugs. Medicare Advantage (Part C) is a private plan that bundles these, often with extras.
Original Medicare leaves real gaps. For example, it does not cover routine dental care, most eyeglasses, hearing aids or long-term custodial care in a nursing home. Skilled nursing coverage ends after 100 days in a benefit period.
Medicaid covers a broad set of services by law: hospital and doctor care, lab work, nursing facility care and more. States can add dental, vision and other benefits. In practice, the biggest difference for families is long-term care. Medicaid is the main public payer for long stays in nursing homes, which Medicare does not cover.
What each costs in 2026
Medicare is not free, even though most people pay no Part A premium. According to the CMS fact sheet on 2026 premiums and deductibles, these are the main numbers:
- Part A premium: $0 for about 99% of people, because they worked at least 40 quarters. Those who did not can buy in for $311 or $565 a month in 2026.
- Part A hospital deductible: $1,736 per benefit period in 2026, up from $1,676 in 2025.
- Part B standard premium: $202.90 a month in 2026, up from $185.00. Higher earners pay more.
- Part B deductible: $283 a year in 2026. After that, you usually pay 20% of approved costs.
Part D and Medicare Advantage premiums depend on the plan you choose. So a realistic Medicare budget includes the Part B premium, a drug plan and some way to cover the 20% coinsurance.
Medicaid works the other way. Most enrollees pay no premium and no deductible. Some states charge small copays for certain services, but costs stay low by design.
Dual eligibility: when you have both
People who qualify for both programs are called dual eligibles. A typical case is a 70-year-old with a small Social Security check and few savings. Medicare pays first for covered services. Medicaid then picks up most of what is left, such as premiums, deductibles and copays. It can also cover services Medicare does not, like long-term nursing home care.
If your income is a bit too high for full Medicaid, a Medicare Savings Program may still help. These state-run programs can pay your Part B premium. The most generous one also covers Medicare deductibles and coinsurance. If you qualify for any of them, you also get Extra Help with Part D drug costs automatically. Income limits change every year, so check current figures with your state.
Medi-Cal: California’s Medicaid and its 2026 changes
Medi-Cal is California’s name for Medicaid. It follows the federal rules but adds state-funded coverage, and several rules changed under the state budget passed in 2025.
- Asset limit is back. Since January 1, 2026, some Medi-Cal programs count savings and property again, including programs for older adults and Medicare Savings Programs. The DHCS asset limit FAQ lists $130,000 for one person, plus $65,000 for each extra household member. Most working-age adults are not affected.
- Enrollment freeze for some adults. Starting January 1, 2026, adults 19 and older without a qualifying immigration status can no longer newly enroll in full-scope Medi-Cal. They can still get restricted coverage for emergency and pregnancy-related care. People already enrolled keep full coverage if they renew on time.
- Premiums planned for 2027. Beginning July 1, 2027, enrollees aged 19 to 59 in that same group are set to pay $30 a month to keep full coverage, according to the DHCS immigrant eligibility FAQ.
Without coverage, many Angelenos rely on free clinics. For example, in 2017 volunteers from Western University of Health Sciences helped at the Care Harbor free clinic in Los Angeles, which offers free care to people who lack insurance.
Federal Medicaid changes from the 2025 budget law
The 2025 federal budget reconciliation law changed Medicaid across the country. The largest change is a work rule, which CMS calls a community engagement requirement. States must start it no later than January 1, 2027, although a few states plan to begin earlier.
The rule applies to adults aged 19 to 64 in the Medicaid expansion group, which in California means Medi-Cal. They must show 80 hours a month of work, community service, a work program or at least half-time school. Earning at least 80 times the federal minimum wage also counts, which is $580 a month in 2026. Many people are exempt, however. The exempt groups include parents and caregivers of young children or people with disabilities, pregnant people, people who are medically frail, veterans with a total disability rating, and American Indians and Alaska Natives. The details are in the CMS fact sheet on the interim final rule, and KFF tracks how each state is putting it in place.
The work rule does not apply to people enrolled in Medicare. So a dual eligible over 65 is not affected by it.
This article is general information. Rules depend on your situation, so check with Medicare, Medi-Cal or your state Medicaid office before you decide.
For more health explainers, see our health and sports guides.
Frequently asked questions
Is Medicare and Medicaid the same thing?
No. Medicare is federal insurance based mainly on age or disability. Medicaid is a state-run program based on income. Some people qualify for both at once.
What is the main difference between Medicare and Medicaid?
Medicare does not look at income, and most people pay premiums and deductibles. Medicaid has an income test but costs little or nothing. Medicaid also covers long-term nursing home care, which Medicare does not.
Can you have Medicare and Medi-Cal at the same time?
Yes. In California, people with both are often called Medi-Medi members. Medicare pays first, and Medi-Cal covers most remaining costs.
Do Medicaid work requirements apply to people on Medicare?
No. The federal rule covers adults 19 to 64 in the expansion group who are not enrolled in Medicare.
