Medicare vs. Medicaid: What's the Difference?

The names are almost the same, which is most of the problem. People mix them up often, and usually at the moment when it matters most.

Here is the short version. Medicare is mostly about your age. Medicaid is mostly about your income.

Medicare is health insurance run by the federal government. It works the same way in every state. What you have saved does not affect whether you can get it. A retired teacher with a comfortable pension and someone living on very little both get the same Medicare.

You qualify if any of these is true:

• You are 65 or older
• You have received Social Security disability benefits for 24 months
• You have ALS, also called Lou Gehrig's disease. Then Medicare starts as soon as your disability benefits do
• You have permanent kidney failure

Medicare comes in parts. Each one pays for a different setting:

• Part A covers inpatient hospital stays (including chemotherapy while you are admitted), skilled nursing facility care, hospice, and some home health care
• Part B covers outpatient care. That means doctor visits and outpatient chemotherapy, such as in a clinic or doctor's office
• Part C, also called Medicare Advantage, is a private plan. It is another way to get your Part A and B benefits, and most plans include drug coverage
• Part D covers prescriptions you pick up at a pharmacy

Medicare is not free. In 2026 the Part B premium is $202.90 a month, or more depending on income, plus a $283 yearly deductible. After that you generally pay 20% of the cost of each covered service. Original Medicare has no yearly limit on what you pay out of pocket. A supplement policy (Medigap) or a Medicare Advantage plan can help with that.

Medicaid is a joint program between the federal government and your state. Washington sets the ground rules and helps pay for it. Your state runs it. So the rules change when you cross a state line, and sometimes even the name changes. You might know it as Medi-Cal, MassHealth, TennCare, or Husky Health.

Medicaid is based on financial need. It serves low-income adults, families and children, pregnant women, older adults, and people with disabilities. Some states have expanded Medicaid to cover more adults with low income.

Do not rule yourself out. Each state sets its own income limits and counts income in its own way. If you are turned down, you may still qualify for Marketplace coverage with savings.

Medicaid is free or low cost.

Millions of people on Medicare also have Medicaid. If you qualify for both, you are dually eligible. The two programs stack rather than compete.

Medicare pays first. Then Medicaid covers your Part B premium and may pay deductibles, coinsurance and copayments, depending on your Medicaid level. Medicaid also adds things Medicare does not usually cover, such as nursing home care and personal care services. For someone facing a long stretch of treatment, that combination can be the difference between manageable bills and impossible ones.

There is also a middle ground people miss. Is your income low, but not low enough for full Medicaid? You may still qualify for a Medicare Savings Program. All of these programs help with your Part B premium, and the QMB program also helps with deductibles and coinsurance. You get Extra Help with prescription costs automatically. In 2026 you pay no more than $12.65 per covered drug with Extra Help.

Both cover cancer care: surgery, chemotherapy, radiation, scans, and hospital stays. The difference shows up in the details.

With Original Medicare, you can go to any doctor or hospital that accepts Medicare. That matters if you want a second opinion, or a specialist center far from home. The trade-off is your share of the bill. With infused chemotherapy, that share can grow quickly.

With Medicaid, your costs are low. But the list of doctors and hospitals that take it can be narrower. Ask early whether your cancer center accepts your state's Medicaid.

For Medicare, apply through Social Security. If you are already receiving Social Security benefits when you turn 65, you are usually enrolled automatically. Otherwise there is a seven-month window, starting three months before your birthday month. Signing up late can mean paying a penalty for as long as you have Part B.

For Medicaid, apply through your state's Medicaid office. There is no enrollment window. You can apply any day of the year. Medicaid may cover medical care from the three months before you apply, depending on your income and expenses.

You do not have to work this out alone. The financial counselor or social worker at your cancer center can also check what you qualify for. It is their job to do it.