Medicare vs Medicaid in New York
The names are one letter apart and the programs are often confused, but they work very differently. Here's the difference in plain terms, and what happens if you qualify for both.
Medicare is federal health insurance for people 65 and older and for some younger people with disabilities; you qualify by age or disability, not by income. Medicaid is health coverage run by New York State for people with limited income and, for many adults 65 and older, limited assets. Medicare doesn't cover most long-term care; Medicaid can. You can have both: Medicaid then helps pay Medicare's premiums and cost-sharing, and you qualify for Extra Help with drug costs.
The difference in one table
| Topic | Medicare | Medicaid (New York) |
|---|---|---|
| Who it's for | People 65 and older, and younger people with certain disabilities, kidney failure or ALS | People with limited income and, for many adults 65 and older, limited assets |
| How you qualify | By age or disability; income doesn't matter | By income, household size and, for many older adults, assets |
| Who runs it | The federal government (CMS), with private Medicare Advantage and Part D plans | New York State, with the counties, under federal rules; many enrollees are in a managed-care plan |
| What it costs you | Premiums, deductibles and copays; the standard Part B premium is $202.90 a month in 2026 | Little or nothing for covered care |
| Long-term care | Not covered beyond short skilled stays and home health | Covers nursing-home and home personal care for people who qualify |
Medicare: insurance you earn by age or disability
Medicare has four parts: hospital (Part A), doctors and outpatient care (Part B), private Medicare Advantage plans (Part C), and drug plans (Part D). Most people get Part A without a premium because they or a spouse paid Medicare taxes while working. You choose between Original Medicare, usually with a supplement and a drug plan, or a Medicare Advantage plan. Medicare Parts A, B, C and D explains each one. Under 65, Medicare starts after 24 months of Social Security disability benefits, or sooner with ALS or kidney failure; see Medicare under 65 on disability.
Medicaid: help based on what you have
Medicaid is for people whose income, and for many adults 65 and older, whose savings and other assets, are under New York's limits. It covers doctor and hospital care and, importantly for older adults, long-term care that Medicare doesn't: home personal care and nursing-home care. If your income is a little over the limit, New York's spend-down (Excess Income) program can still let you qualify for the months your medical bills bring your income down. Where to apply and the asset rules for people 65 and older are in Medicaid for New Yorkers 65 and older.
When you have both
People who have both are called dual eligible. Medicare pays first; Medicaid then covers much of what's left:
- Your Medicare premiums, deductibles and copays, depending on your Medicaid category.
- Care Medicare doesn't cover, such as long-term personal care.
- Extra Help with Part D drug costs, automatically.
Dual-eligible people can also choose a Dual Eligible Special Needs Plan (D-SNP), a Medicare Advantage plan that coordinates both programs. Medicare and Medicaid together: D-SNPs in New York explains who qualifies and what to check.
In between: the Medicare Savings Program
If your income is too high for Medicaid but still modest, New York's Medicare Savings Program can pay your Part B premium, and in its lowest tier your Medicare deductibles and copays too. It has higher income limits than Medicaid and no asset test, and qualifying for it also qualifies you for Extra Help.
Where I fit in
I'm a licensed agent for Medicare plans; I don't sell Medicaid, and Medicaid applications go through the state and your county. What I do is the Medicare side: whether your current plan still fits once Medicaid or the Medicare Savings Program is involved, and whether a D-SNP or Original Medicare makes more sense for your doctors and care. There's no fee.
By county: Albany · Saratoga · Schenectady · Rensselaer · Warren · Washington · Montgomery · Fulton · Columbia · Greene · Schoharie · Otsego · Herkimer · Hamilton · Essex · Ulster · Dutchess. Town pages: every town, grouped by county. Anywhere else in New York.
- Medicaid (Medicare.gov) — how Medicare and Medicaid work together for people who have both
- Parts of Medicare (Medicare.gov)
- Medicare Savings Program (NY Department of Health) — help paying Medicare premiums and cost-sharing
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.
Common questions
Short answers to what people ask before they call.
Still have a question? Call (518) 902-8822 or book a call.
Can I have Medicare and Medicaid at the same time?
Yes. People with both are called dual eligible. Medicare pays first, and Medicaid helps with what's left, such as Medicare premiums, deductibles and copays, and care Medicare doesn't cover, like long-term personal care. You also qualify automatically for Extra Help with Part D drug costs.
Does Medicare pay for a nursing home?
Only for a short skilled stay after a qualifying hospital stay, up to 100 days with daily cost-sharing after day 20. Long-term custodial care in a nursing home is not covered by Medicare; Medicaid is the main public payer for it.
Is Medicaid only for people with very low income?
It's for people with limited income, and for many adults 65 and older there is also an asset (resource) test. New York also has a spend-down (Excess Income) program for people whose income is a bit over the limit, and a Medicare Savings Program with higher income limits and no asset test that helps only with Medicare costs.
What is a D-SNP?
A Dual Eligible Special Needs Plan: a Medicare Advantage plan only for people who have both Medicare and Medicaid. It coordinates the two programs' benefits. Whether one suits you depends on your doctors and the care you need.
Not sure which one applies to you?
Tell me your age, what coverage you have and what worries you about the cost. I'll sort out the Medicare side with you and point you to the right place for Medicaid. No fee.