The fundamental difference
Medicare is a federal health insurance program for people 65 and older (and some younger people with disabilities). It covers medical care — doctor visits, hospital stays, surgeries, and prescription drugs. Eligibility is based on age or disability, NOT income.
Medicaid is a joint federal-state program that provides health coverage and long-term care for people with limited income and assets. Eligibility is based on financial need, and rules vary by state.
Side-by-side comparison
| Feature | Medicare | Medicaid |
|---|---|---|
| Who runs it | Federal government (CMS) | Joint federal-state |
| Who qualifies | Age 65+ or disabled | Low income/assets |
| Based on income? | No | Yes |
| Doctor visits | Yes | Yes |
| Hospital care | Yes | Yes |
| Nursing home (long term) | ❌ 100 days only | ✅ Yes, if eligible |
| Assisted living | ❌ No | Partial, through waivers |
| Prescription drugs | Part D | Yes |
| Dental/vision/hearing | Limited | Varies by state |
⚠️ Medicare's nursing home limitation: Medicare only covers skilled nursing facility care for up to 100 days after a qualifying 3-day hospital stay — and only for skilled care (physical therapy, wound care), not custodial care (help with bathing, dressing, eating). The average nursing home stay is much longer than 100 days. This is where Medicaid planning becomes critical.
Dual eligible — having both Medicare and Medicaid
People who qualify for both Medicare and Medicaid are called "dual eligibles." If you have both, Medicaid typically pays your Medicare premiums, deductibles, and copays — making your healthcare essentially free. About 12 million Americans have both.
Planning for long-term care
Since Medicare doesn't cover long-term nursing home care, planning ahead is essential. The primary options are: long-term care insurance, Medicaid planning (with an elder law attorney), private pay from savings, or VA benefits for veterans.
For detailed Medicaid eligibility rules for your state, visit our sister site:
🧭 State Medicaid guides on The Care Compass →