Medicare is federal health insurance you earn by age (65) or disability, no matter your income. Medicaid is a state-run program for people with limited income and assets, at any age. About one in five people on Medicare also qualify for Medicaid. Those dual-eligible beneficiaries get help with Medicare premiums and cost sharing, and can join special Medicare Advantage plans built for them.
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | Federal government (CMS) | Each state, under federal rules |
| Who qualifies | Age 65+, or under 65 with a disability, ALS or ESRD | Low income and limited assets; rules differ by state |
| What it costs you | Part B premium ($202.90 in 2026), deductibles, 20% coinsurance | Usually free or very low cost |
| Covers | Hospital, medical, drugs (with Part D) | Hospital, medical, drugs, and long-term care such as nursing homes |
| Long-term care | Up to 100 days of skilled nursing after a hospital stay only | Yes, including nursing home care, when you qualify |
When you qualify for both
If you are on Medicare and your income and assets are low enough, you can also get Medicaid. Medicare pays first, Medicaid pays second, and together they can cover nearly all of your costs. In Utah, Medicaid eligibility and applications run through the Department of Workforce Services; each state sets its own limits.
Help that sits between the two
- Medicare Savings Programs (QMB, SLMB, QI): state programs that pay your Part B premium, and for QMB also your deductibles and coinsurance, if your income is under the state limit.
- Extra Help (the Part D Low-Income Subsidy): pays most of your Part D premium and lowers your copays to a few dollars per prescription. Anyone on Medicaid or a Medicare Savings Program gets it automatically.
- Dual Eligible Special Needs Plans (D-SNPs): Medicare Advantage plans designed for people with both programs, with care coordination and extra benefits.
What people mix up
Medicare does not pay for long-term nursing home care; Medicaid does. Medicare is not free; Part B has a premium. And Medicaid is not only for people under 65: a large share of nursing home residents are over 65 and on both programs.
Source: Medicare.gov, Medicaid and Medicare dual eligibility.