Medicare and Medicaid — two programs with similar names that confuse millions of Americans every year. If you're navigating post-acute care for yourself or a loved one, understanding the difference between these two programs isn't just academic — it directly affects what care you can access, how much you'll pay, and which providers you can use. In many cases, you may qualify for both programs simultaneously, unlocking benefits that neither program provides alone.

This guide breaks down the key differences between Medicare and Medicaid, explains how each program covers post-acute care services, and helps you understand how to maximize your benefits if you qualify for both.

In This Guide

Medicare and Medicaid at a Glance
Who Qualifies for Medicare?
Who Qualifies for Medicaid?
How Medicare Covers Post-Acute Care
How Medicaid Covers Post-Acute Care
Dual Eligibility: When You Have Both Medicare and Medicaid
Side-by-Side Comparison for Post-Acute Care
How to Apply for Medicaid
Medicaid Long-Term Care Planning
Finding Providers That Accept Both Medicare and Medicaid
Related NDPAP Resources

Medicare and Medicaid at a Glance

Before diving into the details, here's the fundamental distinction: Medicare is a federal health insurance program based primarily on age or disability. Medicaid is a joint federal-state assistance program based primarily on income and financial need.

Medicare is administered by the federal government through the Centers for Medicare & Medicaid Services (CMS) and provides the same basic benefits nationwide. Medicaid is administered by individual states within federal guidelines, which means benefits, eligibility rules, and covered services vary significantly from state to state.

Who Qualifies for Medicare?

You're eligible for Medicare if you are 65 or older and you or your spouse paid Medicare taxes for at least 10 years, under 65 with a qualifying disability (after a 24-month waiting period from the start of Social Security Disability benefits), or diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), regardless of age.

Medicare eligibility is not based on income. A billionaire and a person living on Social Security both qualify for the same Medicare benefits at age 65.

The Four Parts of Medicare

Medicare Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care (up to 100 days after a qualifying hospital stay), home health care, and hospice care. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working.

Medicare Part B (Medical Insurance) covers doctor visits and outpatient services, durable medical equipment, outpatient therapy (physical, occupational, speech), preventive services, and mental health services. Part B requires a monthly premium (standard premium was $185 in 2025, with higher-income beneficiaries paying more).

Medicare Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurance companies. These plans bundle Parts A and B benefits and often include prescription drug coverage and additional benefits.

Medicare Part D (Prescription Drug Coverage) covers outpatient prescription medications through private insurance plans.

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Who Qualifies for Medicaid?

Medicaid eligibility is based primarily on income and assets, and the rules vary by state. Generally, you may qualify if you are a low-income adult (in states that expanded Medicaid under the Affordable Care Act), a pregnant woman with income below a certain threshold, a child or parent with low income, an elderly adult with limited income and resources, or a person with a disability who meets financial criteria.

Income limits vary significantly by state. Some states have expanded Medicaid to cover all adults with incomes up to 138% of the federal poverty level, while others have more restrictive eligibility requirements. The Kaiser Family Foundation maintains current information about Medicaid eligibility by state.

How Medicare Covers Post-Acute Care

Medicare's post-acute care coverage is designed for recovery and rehabilitation. It covers skilled, medically necessary services but has important limitations:

Home Health Care

Medicare covers skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide services, and medical social services when you are homebound and need skilled care. There is no copay for covered home health services — this is one of Medicare's most generous benefits.

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Skilled Nursing Facility Care

Medicare covers up to 100 days per benefit period in a skilled nursing facility following a qualifying 3-day hospital stay. Days 1-20 have no copay; days 21-100 have a significant daily copay. After 100 days, Medicare coverage ends entirely.

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Hospice Care

Medicare covers comprehensive hospice services with virtually no cost to the patient, including nursing, medications, equipment, counseling, and bereavement support.

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Durable Medical Equipment

Medicare Part B covers wheelchairs, hospital beds, oxygen equipment, walkers, and other medically necessary equipment with a 20% copay after the Part B deductible.

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What Medicare Does NOT Cover

Medicare does not cover long-term custodial care (nursing home care when you don't need skilled services), assisted living or memory care facility costs, personal care assistance without a skilled component, and most long-term supports and services.

This is the biggest gap in Medicare's coverage — and it's where Medicaid becomes essential for millions of Americans.

📋 Understanding Your Care Options? Read: What Happens After the Hospital: A Step-by-Step Guide to Post-Acute Care

How Medicaid Covers Post-Acute Care

Medicaid's post-acute care coverage is broader than Medicare's in several important ways, particularly for long-term care. However, the specific services covered and the eligibility rules vary by state.

Long-Term Nursing Home Care

This is Medicaid's most significant role in post-acute care. Medicaid is the primary payer for long-term nursing home care in the United States, covering approximately 62% of all nursing home residents. When Medicare's 100-day skilled nursing benefit runs out and a patient still needs nursing home care, Medicaid steps in for those who qualify financially.

Home and Community-Based Services (HCBS)

Medicaid HCBS waiver programs cover services that help people live in the community rather than in institutions. These may include personal care assistance (help with bathing, dressing, meal preparation), homemaker services (cooking, cleaning, laundry), adult day care, respite care for family caregivers, home modifications, transportation, and care coordination. These are services that Medicare generally does not cover, making Medicaid waivers invaluable for people who need ongoing daily assistance.

Assisted Living

While Medicare doesn't cover assisted living, many states' Medicaid programs do provide coverage through HCBS waiver programs. Coverage varies dramatically by state — some states cover the full cost of assisted living, while others cover only certain services.

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Personal Care Services

Medicaid covers personal care attendants who help with activities of daily living — a service Medicare doesn't provide outside of the home health aide benefit (which requires concurrent skilled care).

Mental Health Services

Medicaid often covers more comprehensive mental health services than Medicare, including case management, peer support, and community-based mental health programs.

Dual Eligibility: When You Have Both Medicare and Medicaid

Approximately 12.3 million Americans — known as "dual eligibles" or "dually eligible individuals" — qualify for both Medicare and Medicaid simultaneously. This typically includes people over 65 with limited income and resources, people under 65 with disabilities who have low income, and people with ESRD who meet Medicaid's financial criteria.

Having both programs provides the most comprehensive coverage available. Here's how the programs work together:

Medicare is the primary payer for most medical services. It covers hospital stays, doctor visits, skilled nursing, home health, hospice, and outpatient services first.

Medicaid is the secondary payer, picking up costs that Medicare doesn't cover. This includes Medicare premiums, deductibles, and copays (Medicaid may pay some or all of your Medicare cost-sharing), long-term nursing home care after Medicare's 100-day benefit expires, personal care services and home and community-based services, dental, vision, and hearing services (which have limited Medicare coverage), prescription drug cost-sharing, and transportation to medical appointments.

Medicare Savings Programs

Even if you don't qualify for full Medicaid benefits, you may qualify for a Medicare Savings Program that helps pay your Medicare costs. The Social Security Administration and your state Medicaid office can help determine your eligibility for these programs, which include the Qualified Medicare Beneficiary (QMB) program (pays your Part A and Part B premiums, deductibles, and copays), the Specified Low-Income Medicare Beneficiary (SLMB) program (pays your Part B premium), and the Qualifying Individual (QI) program (pays your Part B premium).

Dual-Eligible Special Needs Plans (D-SNPs)

If you qualify for both Medicare and Medicaid, you may be able to enroll in a Dual-Eligible Special Needs Plan. These Medicare Advantage plans are specifically designed for people with both programs and coordinate benefits between Medicare and Medicaid in a single plan, often provide additional benefits beyond standard Medicare, may simplify billing and reduce paperwork, and frequently include care coordination services.

Side-by-Side Comparison for Post-Acute Care

Home Health Care: Medicare covers skilled services with no copay when homebound. Medicaid covers personal care and homemaker services that Medicare doesn't, plus may cover skilled services for those not eligible for Medicare.

Skilled Nursing Facility: Medicare covers up to 100 days per benefit period (with copays after day 20). Medicaid covers long-term nursing home care for qualifying individuals with no time limit.

Assisted Living: Medicare does not cover. Medicaid may cover through HCBS waiver programs (varies by state).

Hospice: Medicare provides comprehensive coverage with minimal copays. Medicaid also covers hospice (for those without Medicare, Medicaid is the primary payer).

DME: Medicare covers with 20% copay. Medicaid may cover the copay for dual eligibles and covers DME for Medicaid-only beneficiaries.

Personal Care: Medicare covers only through home health aide services (requires concurrent skilled need). Medicaid covers personal care attendants independently.

Medications: Medicare Part D covers prescriptions (with copays, deductibles, and coverage gap). Medicaid covers prescriptions with minimal or no cost-sharing.

How to Apply for Medicaid

If you think you might qualify for Medicaid, here's how to apply. Contact your state Medicaid office — you can find your state's contact information at Medicaid.gov. Apply online through your state's Medicaid website or the Health Insurance Marketplace at HealthCare.gov. Visit your local Department of Social Services or Area Agency on Aging for in-person assistance. Contact your State Health Insurance Assistance Program (SHIP) for free counseling on both Medicare and Medicaid.

The application process typically requires documentation of income, assets, residency, citizenship status, and medical condition. Processing times vary by state but generally take 30-90 days.

Medicaid Long-Term Care Planning

Qualifying for Medicaid's long-term care benefits often requires meeting strict financial criteria. Many families work with elder law attorneys to develop legal strategies for protecting assets while qualifying for Medicaid. The National Academy of Elder Law Attorneys (NAELA) can help you find a qualified attorney in your area.

Important considerations for Medicaid planning include the look-back period (Medicaid examines asset transfers made within the previous 5 years and may impose penalties for improper transfers), spousal protections (the "community spouse" is allowed to keep a certain amount of income and assets), and estate recovery (states may seek to recover Medicaid costs from the estate of deceased Medicaid recipients).

Never attempt Medicaid asset planning without professional guidance. Improper planning can result in penalties that delay eligibility and leave your loved one without coverage.

Finding Providers That Accept Both Medicare and Medicaid

Not all healthcare providers accept both Medicare and Medicaid. When searching for post-acute care providers, ask whether they accept your specific insurance (Medicare, Medicaid, or both), whether they are enrolled as a provider with your state's Medicaid program, whether there are any limitations on services for Medicaid patients, and how they handle billing for dual-eligible patients.

NDPAP's directory of over 77,900 post-acute care providers can help you find home health agencies, skilled nursing facilities, assisted living facilities, hospice providers, DME suppliers, and other care providers in your area.

Search for post-acute care providers on NDPAP →

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Understanding Medicare Coverage for Post-Acute Care — comprehensive Medicare overview
Does Medicare Cover Home Health Care? — detailed home health benefits guide
Does Medicare Cover Skilled Nursing Facility Care? — SNF coverage explained
Does Medicare Pay for Assisted Living? — assisted living payment options
How Much Does Hospice Care Cost? — hospice cost breakdown

This article is for informational purposes only and does not constitute legal or financial advice. Medicare and Medicaid rules change regularly, and Medicaid varies significantly by state. For Medicare information, visit Medicare.gov or call 1-800-MEDICARE. For Medicaid information, visit Medicaid.gov or contact your state Medicaid office. For free personalized counseling, contact your local State Health Insurance Assistance Program (SHIP).

Medicare vs. Medicaid for Post-Acute Care (2026 Guide)

In This Guide

Medicare and Medicaid at a Glance