Medicare vs Medicaid: What Is the Difference?
Medicare is federal health insurance for people 65 or older and for some younger people with a disability, End-Stage Renal Disease (ESRD) or ALS. Medicare eligibility does not depend on income, though higher-income people pay more for Part B and Part D (called IRMAA). Medicaid is a joint federal and state program for people with limited income and resources, and its rules are different in each state. You can have both, and people who do are called dually eligible. Even if you do not qualify for full Medicaid, your state may help pay Medicare costs through the Medicare Savings Programs (QMB, SLMB and QI), and Social Security runs Extra Help for drug plan costs. The screener below checks your numbers against the 2026 federal limits, and the page explains each program and how to apply.
Maintained by Archie Chang · Rules and limits checked against Medicare.gov, CMS and SSA on October 28, 2026 · Methodology & sources
Medicare vs Medicaid side by side
As of October 28, 2026, this is how the two programs differ, in plain words, with the source for each row. The short version: Medicare is one national program with age and disability rules; Medicaid is run state by state and depends on income and resources.
| Medicare | Medicaid | |
|---|---|---|
| Who it is for | People 65 or older who meet citizenship or residency requirements, and some younger people with a disability, ESRD or ALS.Source: Medicare.gov, Get started with Medicare | Certain low-income people, families and children, pregnant women, the elderly and people with disabilities, and other adults.Source: Medicare.gov, Medicaid |
| Who runs it | “A federal agency called the Centers for Medicare & Medicaid Services runs Medicare.”HHS.gov, What’s the difference between Medicare and Medicaid?Whether you are enrolled automatically depends on whether you already get Social Security retirement or disability benefits.Source: Medicare.gov, Get started with Medicare | The federal government and your state together. Your State Medical Assistance (Medicaid) office takes applications and decides.Source: Medicare.gov, Medicaid; SSA POMS HI 00815.023 |
| Eligibility | Based on age, disability, ESRD or ALS, and citizenship or residency. Not means-tested: income is not one of the eligibility rules Medicare.gov lists.Source: Medicare.gov, Get started with Medicare | “Generally, you must meet your state’s rules for your income and resources, and other rules (like being a resident of the state).”Medicare.gov, Medicaid“The rules around who’s eligible for Medicaid are different in each state.”Medicare.gov, Medicaid |
| What it covers | Part A (Hospital Insurance): inpatient hospital stays, skilled nursing facility care, hospice care and some home health care. Part B (Medical Insurance): certain doctors’ services, outpatient care, medical supplies and preventive services. Drug coverage comes from a Medicare drug plan (Part D).Source: Medicare.gov, Medicare Savings Programs and Medicaid pages | “Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.”Medicare.gov, Medicare Savings Programs“Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services.”Medicare.gov, Medicaid |
| What it costs | Premiums, deductibles, coinsurance and copayments. For 2026 CMS set the standard Part B premium at $202.90 a month and the Part B deductible at $283 a year. People with higher incomes pay an income-related surcharge: see the IRMAA calculator.Source: CMS 2026 Parts A & B fact sheet | Depends on your state’s program and your level of coverage. As one example, Medicare.gov says people in QMB may get a bill for a small Medicaid copayment, if one applies.Source: Medicare.gov, Medicare Savings Programs |
| How to apply | Some people get Medicare automatically and others have to sign up. It depends on whether you start getting retirement or disability benefits from Social Security before you turn 65.Source: Medicare.gov, Get started with Medicare | “Contact your State Medical Assistance (Medicaid) office.”Medicare.gov, Medicaid |
Medicare eligibility does not depend on income, but what you pay for Part B does. CMS says:
“Since 2007, a beneficiary’s Part B monthly premium has been based on his or her income.”
Those income-related amounts are called IRMAA; the IRMAA calculator shows yours.
In the sources’ own words, Medicare is:
“Medicare is health insurance for people 65 or older who meet citizenship or residency requirements.”
“You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).”
And Medicaid is:
“Medicaid is a joint federal and state program that helps cover medical costs for certain low-income people, families and children, pregnant women, the elderly, and people with disabilities.”
Might I qualify for help with Medicare costs?
This screener compares your numbers with the 2026 federal limits (as of October 28, 2026). It is a screener, not an application, and nothing you type is sent anywhere.
Medicare.gov lists money in checking, savings or retirement accounts, stocks and bonds as resources, and says states do not count your home, one car, a burial plot, or up to $1,500 set aside for burial expenses. Enter your best estimate in whole dollars.
What the 2026 federal limits suggest
Medicare Savings Programs (help with Part A and Part B costs)
On these numbers you may qualify for Qualified Medicare Beneficiary (QMB). Your state decides.
Your income is at or below the QMB limit of $1,350 a month. Your state decides which program you are placed in.
Extra Help (help with Part D drug plan costs)
On these numbers you may qualify for Extra Help; Social Security decides. After the $20 general income exclusion, your income is about $11,760 a year, below the limit of $23,940, and your resources are within $18,090.
Every result here is a “may qualify — your state decides” result. States can use higher limits than the federal ones, and your state (for Medicare Savings Programs) or Social Security (for Extra Help) makes the actual decision. SLMB and QI also need both Part A and Part B. This is a screener, not an application.
People who have both: dual eligibility
You can have Medicare and Medicaid at the same time. Medicare.gov calls people who have Medicare and full-benefit Medicaid coverage “dually eligible.” Medicare is the first payer:
“Medicare pays first when you’re a dual eligible and you get Medicare-covered services.”
“Medicaid pays last, after Medicare and any other health insurance you have.”
If you have Medicare and qualify for full-benefit Medicaid, Medicaid can pay part of your Medicare costs:
“Your state will pay your Medicare Part B (Medical Insurance) monthly premiums.”
Depending on your level of Medicaid, Medicare.gov says your state might also pay your share of Medicare costs (deductibles, coinsurance and copayments) and your Part A premium if you have to pay one. Medicaid may also pay for drugs and services Medicare does not cover. For prescriptions:
“If you're dually eligible, Medicare covers your prescription drugs.”
“You'll automatically get Extra Help with your drug costs.”
You still choose between Original Medicare and a Medicare Advantage plan. Medicare.gov says there are special plans for dual eligibles, such as Special Needs Plans, and Program of All-Inclusive Care for the Elderly (PACE) plans, which can help certain people get care outside a nursing home.
Some people have only help with Medicare costs from their state, without full Medicaid. That is what the Medicare Savings Programs below are. To see what a Part B premium is before any help, see the Medicare Part B premium for 2027 page; the 2026 standard premium is $202.90 a month. CMS says:
“The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025.”
Medicare Savings Programs (QMB, SLMB, QI): 2026 limits
As of October 28, 2026, here is what the sources say the Medicare Savings Programs are:
“The Medicare Savings Programs (MSPs) are mandatory Medicaid eligibility groups that assist low-income Medicare beneficiaries with some or all of their Parts A and B premiums and cost-sharing.”
“Get help from your state paying your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums through a Medicare Savings Program.”
“If you qualify, Medicare Savings Programs might also pay your Part A and Part B deductibles, coinsurance, and copayments.”
The table gives the 2026 federal monthly income limits and resource limits for the 48 contiguous states and DC, as Medicare.gov and the CMS chart state them. Resource limits are the same in every state group.
| Program | What Medicare.gov says it helps pay | Monthly income limit, individual | Monthly income limit, married couple | Resource limit (individual / couple) |
|---|---|---|---|---|
| Qualified Medicare Beneficiary (QMB) | “Helps pay for: Part A premiums (if you don't have premium-free Part A); Part B premiums, deductibles, coinsurance, and copayments (for services and items Medicare covers).”Medicare.gov, Medicare Savings Programs | $1,350 | $1,824 | $9,950 / $14,910 |
| Specified Low-Income Medicare Beneficiary (SLMB) | “Helps pay for: Part B premiums only (You must have both Part A and Part B to qualify.)”Medicare.gov, Medicare Savings Programs | $1,616 | $2,184 | $9,950 / $14,910 |
| Qualifying Individual (QI) | “Helps pay for: Part B premiums (You must have both Part A and Part B to qualify.)”Medicare.gov, Medicare Savings Programs | $1,816 | $2,455 | $9,950 / $14,910 |
Alaska and Hawaii have higher income limits
Medicare.gov says:
“Income limits slightly higher in Alaska and Hawaii.”
The figures come from the chart CMS attached to its January 2026 bulletin. CMS says:
“Included with this informational bulletin is the 2026 Dual Eligible Standards chart that displays the new standards for the Medicare Savings Program categories.”
The chart’s Alaska and Hawaii income limits are below, and the resource limits are the same as above:
| Program | Alaska, individual | Alaska, couple | Hawaii, individual | Hawaii, couple |
|---|---|---|---|---|
| QMB | $1,683 | $2,275 | $1,550 | $2,095 |
| SLMB | $2,015 | $2,725 | $1,856 | $2,509 |
| QI | $2,265 | $3,064 | $2,086 | $2,821 |
Source: CMS, CMCS Informational Bulletin of January 23, 2026, 2026 Dual Eligible Standards chart.
The $20 income disregard
The CMS chart labels these limits as a percentage of the federal poverty level plus $20 (100% for QMB, 120% for SLMB and 135% for QI). The $20 is the SSI income disregard, so it is already built into the figures above. SSA’s manual says:
“$20 = monthly SSI general income exclusion.”
Your state also subtracts other income by its own rules, so your gross income is only a first check. Your Social Security benefit changes each year with the cost-of-living adjustment; see the Social Security COLA for 2027 to plan ahead, and note that the limits go up each year too.
Your state can use higher limits
“State Medicaid agencies determine whether or not an individual is eligible for Medicaid coverage, including the MSPs.”
“You may still qualify for these programs in your state even if your income or resources are higher than the federal limits listed.”
“Some states don’t count certain types or specific amounts of income or resources when deciding who qualifies.”
“States can, however, effectively raise these limits for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individuals (QI) eligibility groups above the federal statutory limits by disregarding amounts or certain types of income and resources.”
“Some states have used this authority to effectively eliminate resources tests when determining eligibility for these MSP eligibility groups.”
So a federal figure is a floor, not a ceiling, in some states. Social Security’s own manual tells its staff to encourage people to apply for these programs even if their income or resources look somewhat higher than their state’s limits.
Where the income lines fall
The three programs are income bands, and the statute draws the lines. A person with income at or below the QMB level is a QMB; the SLMB and QI wording says “less than”, so income exactly at a published SLMB or QI figure is not under it. SSA’s manual says CMS rounds the monthly limits up to the nearest dollar, so a figure exactly at a limit is a boundary case that your state works out. The statute’s words:
“does not exceed an income level established by the State consistent with paragraph (2)”
“their income exceeds the income level established by the State under section 1396d(p)(2) of this title but is less than 110 percent in 1993 and 1994, and 120 percent in 1995 and years thereafter of the official poverty line”
“their income exceeds the income level established by the State under section 1396d(p)(2) of this title and is at least 120 percent, but less than 135 percent, of the official poverty line”
That is why the screener names one program for your income and says “right at the limit” when your income equals the SLMB or QI figure.
What each program does and who decides
- QMB is the broadest. If you are in it:
“Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments.”
Medicare.gov, Medicare Savings Programs “You may get a bill for a small Medicaid copayment, if one applies.”
Medicare.gov, Medicare Savings Programs - SLMB helps pay the Part B premium only, and you must have both Part A and Part B.
- QI also helps pay the Part B premium and needs both Part A and Part B. If you qualify for it, Medicare.gov says:
“You must apply every year to stay in the QI Program.”
Medicare.gov, Medicare Savings Programs “States approve applications on a first-come, first-served basis – priority is given to people who got QI benefits the previous year.”
Medicare.gov, Medicare Savings Programs Medicare.gov also says QI is only available to people who do not qualify for any other Medicaid coverage or benefits, but you may qualify for help from another Medicare Savings Program.
“When you apply, your state determines which program(s) you qualify for.”
People in QMB, SLMB or QI also get Extra Help with drug costs (see below). Medicare.gov says, for each of the three:
“You’ll also get Extra Help paying for your prescription drugs.”
Medicare.gov lists a fourth program, QDWI, for people with a disability who are working and lost premium-free Part A when they returned to work; it helps pay the Part A premium only. The screener does not check QDWI.
Extra Help (Part D Low-Income Subsidy) in 2026
Extra Help is a different program from the Medicare Savings Programs: it lowers Medicare drug plan costs. Medicare.gov defines it this way:
“A Medicare program for people with limited income and resources that helps lower Medicare drug plan costs (like premiums, deductibles, and coinsurance).”
“You also won't have to pay a Part D late enrollment penalty while you get Extra Help.”
The late enrollment penalty it mentions is the Part D one; see the Medicare late enrollment penalty calculator for how penalties are figured.
As of October 28, 2026, the 2026 limits are below. Social Security’s booklet gives the 48-state figures, and Medicare.gov gives the Alaska and Hawaii figures. Income is a yearly amount here, not monthly:
| State group | Annual income, individual | Annual income, married couple | Resources, individual / couple |
|---|---|---|---|
| 48 contiguous states and DC | $23,940 | $32,460 | $18,090 / $36,100 |
| Alaska | $29,925 | $40,575 | $18,090 / $36,100 |
| Hawaii | $27,540 | $37,335 | $18,090 / $36,100 |
Social Security’s booklet words it this way:
“To be eligible for Extra Help, your annual income must be limited to $23,940 for a person or $32,460 for a married couple living together.”
“To be eligible for Extra Help, your resources must be limited to $18,090 for a person or $36,100 for a married couple living together.”
The resource figures include $1,500 per person for burial expenses. SSA’s manual says so in a note on the 2026 amounts:
“$18,090 for a single beneficiary and $36,100 for a couple (systems includes the $1500 per person for burial expenses)”
SSA subtracts a $20 general income exclusion first
The income limit applies to income after exclusions, and the statute says “below”:
“Income after exclusions, whether earned and unearned, must be less than 150% of the FPL (based on size of the household) for subsidy eligibility.”
“has income below 150 percent of the poverty line applicable to a family of the size involved”
SSA’s manual shows how it works in an example, which takes 12 times the $20 general income exclusion off a year of unearned income (benefits and pensions):
“$240 (12 x the $20 general income exclusion) Total Countable Unearned Income = $21,960”
So for unearned income, SSA subtracts a $20 general income exclusion each month before it compares you with the limit; the screener does the same. Earnings and other exclusions can lower your countable income further, and income exactly at the limit is a boundary case that Social Security works out.
The same booklet says some people with higher income can still get Extra Help, for example if they or their spouse support other family members who live with them, have earnings from work, or live in Alaska or Hawaii. SSA’s manual explains the higher Alaska and Hawaii limits:
“Alaska and Hawaii have separate and slightly higher poverty levels.”
Extra Help has no separate figures for the U.S. territories, because it is not available there. Medicare.gov says:
“Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas.”
Who gets Extra Help automatically
“Some people qualify for Extra Help automatically, and other people have to apply.”
Medicare.gov says you get Extra Help automatically if you get full-benefit Medicaid coverage, help from your state paying your Part B premiums through a Medicare Savings Program, or Supplemental Security Income (SSI) payments. SSA’s manual says:
“Certain beneficiaries are automatically deemed subsidy-eligible and should not complete an application for Extra Help.”
That includes QMB, SLMB and QI. SSA’s manual adds that people in QDWI are not deemed eligible for Extra Help, so they have to apply.
How to apply for help with Medicare costs
- Medicare Savings Programs: apply through your state.
“These programs are run by your state.”
Medicare.gov, Medicare Savings Programs “You’ll apply for Medicare Savings Programs through your state.”
Medicare.gov, Medicare Savings Programs Contact your State Medical Assistance (Medicaid) office. Medicare.gov adds:
“Even if you don’t think you qualify, you should still apply.”
Medicare.gov, Medicare Savings Programs - Extra Help: apply to Social Security (or your state), unless you already get it automatically.
Social Security’s booklet lists three ways: online at www.ssa.gov/medicare/part-d-extra-help, by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or request an application, or at your local Social Security office. SSA’s page says:
“You can apply for Extra Help any time before or after you enroll in Part D.”
SSA, Apply for Part D Extra Help SSA’s page suggests having bank statements and tax returns, IRA or 401(k) balances, and statements for pensions, Veterans’ benefits, annuities and Railroad Retirement Board benefits for you and your spouse ready.
- Apply for both at the same time if you want to.
“You can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time.”
Medicare.gov, Help with drug costs (Extra Help) “Social Security will send information to your state to initiate an MSP application unless you tell them not to on the Extra Help application.”
Medicare.gov, Help with drug costs (Extra Help) - Need help filling it out? Medicare.gov says your local State Health Insurance Assistance Program (SHIP) gives free help applying for Extra Help.
Need to know what you might pay for Medicare before any help? Use the IRMAA calculator for the Part B and Part D premiums by income.
Medicare vs Medicaid questions
What is the main difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65 or older and for some younger people with a disability, End-Stage Renal Disease (ESRD) or ALS. Medicare eligibility does not depend on income: Medicare.gov’s description of who gets Medicare lists age, disability, ESRD, ALS and citizenship or residency. But higher-income people pay more for Part B and Part D, an extra charge called IRMAA. Medicaid is a joint federal and state program for people with limited income and resources, and the rules are different in each state. Medicaid also covers things Medicare does not normally cover, like nursing home care and personal care services. You can have both.
Can I have Medicare and Medicaid at the same time?
Yes. People who have both Medicare and full-benefit Medicaid coverage are called dually eligible. Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other health insurance you have. If you are dually eligible, Medicare covers your prescription drugs through a Medicare drug plan, and you automatically get Extra Help with drug costs. Some people get only help with Medicare costs from their state, through a Medicare Savings Program, without full Medicaid.
Does Medicaid pay my Medicare premiums and deductibles?
It can. If you have Medicare and qualify for full-benefit Medicaid, your state will pay your Part B premium, and depending on your level of Medicaid it might also pay deductibles, coinsurance and copayments, and the Part A premium if you owe one. The Medicare Savings Programs are the state programs built for this: QMB helps pay Part A premiums (if you do not have premium-free Part A), Part B premiums, deductibles, coinsurance and copayments, while SLMB and QI help pay the Part B premium only. For scale, CMS says the standard Part B premium is $202.90 a month for 2026.
What are the 2026 income and resource limits for the Medicare Savings Programs?
As of October 28, 2026, the federal limits for 2026 outside Alaska and Hawaii are monthly income of $1,350 for one person and $1,824 for a married couple for QMB, $1,616 and $2,184 for SLMB, and $1,816 and $2,455 for QI. The resource limit is $9,950 for one person and $14,910 for a couple. CMS’s chart builds in a $20 monthly income disregard. Alaska and Hawaii have higher income limits, listed in the table on this page. States can raise these limits by not counting some income or resources, and some states have effectively eliminated the resource test, so you may qualify in your state even if you are over a federal figure. Your state decides.
What is Extra Help, and is it the same as a Medicare Savings Program?
No. Extra Help (the Part D Low-Income Subsidy) helps people with limited income and resources pay Medicare drug plan costs like premiums, deductibles and coinsurance. A Medicare Savings Program helps with Part A and Part B costs. For 2026, SSA’s booklet gives an annual income limit of $23,940 and a resource limit of $18,090 for one person, and $32,460 and $36,100 for a married couple living together; the income limits are higher in Alaska and Hawaii. People who get full Medicaid, a Medicare Savings Program (QMB, SLMB or QI) or SSI get Extra Help automatically.
How do I apply for help with Medicare costs?
For a Medicare Savings Program, contact your State Medical Assistance (Medicaid) office. These programs are run by your state. Medicare.gov says to apply even if you do not think you qualify. Your state determines which program or programs you qualify for. For Extra Help, apply to Social Security online at ssa.gov/medicare/part-d-extra-help, by calling 1-800-772-1213 (TTY 1-800-325-0778), or at your local Social Security office. You can apply for Extra Help and a Medicare Savings Program at the same time, and Social Security will send information to your state to start an MSP application unless you tell them not to on the Extra Help application.
Authoritative sources: Medicare.gov: Get started with Medicare · Medicare.gov: Medicaid · Medicare.gov: Medicare Savings Programs · Medicare.gov: Help with drug costs (Extra Help) · CMS: 2026 Dual Eligible Standards (CMCS Informational Bulletin, Jan. 23, 2026) · CMS: 2026 Medicare Parts A & B premiums and deductibles · SSA: Apply for Part D Extra Help · SSA: Understanding the Extra Help with Your Medicare Prescription Drug Plan (EN-05-10508) · SSA POMS HI 03001.005: Medicare Part D Extra Help · SSA POMS HI 03001.020: Eligibility for Extra Help · SSA POMS HI 00815.023: Medicare Savings Programs income and resource limits · SSA POMS HI 03020.055: Income limits for Extra Help · HHS: What’s the difference between Medicare and Medicaid? · 42 U.S.C. 1396d(p): qualified medicare beneficiary (Cornell LII) · 42 U.S.C. 1396a(a)(10)(E): QMB, SLMB and QI coverage (Cornell LII) · 42 U.S.C. 1395w-114(a)(3)(A): subsidy eligible individual (Cornell LII)