Medicare is federal health insurance for people 65 and older (and some younger people with disabilities), and it has no income test. Medicaid is a joint federal and state program for people with limited income and resources, and unlike Medicare it pays for nursing home care and personal care. Many older New Yorkers have both, and then Medicare pays first and Medicaid fills in.
What is the difference between Medicare and Medicaid?
The short version: Medicare depends on your age or disability. Medicaid depends on your income and resources. Medicaid rules are set state by state.
| Medicare | Medicaid (New York) | |
|---|---|---|
| Who it serves | People 65 or older who meet citizenship or residency rules. Younger people with a disability, End-Stage Renal Disease or ALS can qualify earlier | Certain low-income people, including older adults and people with disabilities, who meet New York’s income and resource rules |
| Who runs and pays | Federal program. You pay premiums, deductibles and coinsurance | Joint federal and state program. Medicaid pays last, after Medicare and any other insurance |
| Income test | No | Yes, and resources are counted too |
| Long-term care | No. Medicare.gov says it does not pay for long-term (custodial) care | Yes, for people who qualify: nursing home care and personal care services |
| How you apply | Through Social Security | Through NY State of Health or your local social services office (HRA in New York City) |
See Medicare.gov’s sign-up overview and its Medicaid page.
What does each one cover?
Medicare covers the medical side of aging: hospital stays, doctor visits and short-term skilled care after an illness or surgery. Medicaid covers much of the daily-living side, which is where most long-term needs sit. Here is how that plays out in 2026 figures from Medicare.gov.
| Service | Medicare | Medicaid |
|---|---|---|
| Hospital stay | Part A. $1,736 deductible per benefit period, then $0 for days 1 to 60 and $434 a day for days 61 to 90 | For people with both, the state may pay your Medicare costs, depending on your Medicaid level |
| Doctor visits | Part B. $283 deductible, then usually 20% of the approved amount | Same: may pay your share if you qualify |
| Skilled nursing and therapy at home | Yes, part-time, if the person is homebound and a provider orders it (see our Medicare home care guide) | Managed long term care plans can include nursing, therapies and home health aide services |
| Nursing home | Skilled care only: up to 100 days per benefit period after a qualifying 3-day hospital stay. $0 for days 1 to 20, $217 a day for days 21 to 100 | Long-term nursing home care for people who qualify |
| Personal care and CDPAP at home | No | Yes, through personal care services, CDPAP or a managed long term care plan (see our Medicaid home care guide) |
| Adult day health care | No, it is listed as long-term care | Part of the community services in New York’s managed long term care program |
| Dental, routine eye exams, hearing aids | Original Medicare does not cover most dental services, routine eye exams or hearing aids. Some Medicare Advantage plans add them | Ask your Medicaid plan what it covers |
The Medicare rules for home health are on Medicare.gov’s home health page and for nursing facilities on its skilled nursing facility page. A stay under “observation” in the hospital does not count toward the 3 days.
Who pays, and what do you pay?
Medicare is not free. Part A is $0 a month for most people because they or a spouse paid Medicare taxes long enough. Part B costs $202.90 a month in 2026 for most people, more at higher incomes. Original Medicare leaves deductibles and coinsurance with you.
Medicaid works the other way around. If you have Medicare and qualify for full Medicaid, the state pays your Part B premium and, depending on your Medicaid level, may also pay deductibles, coinsurance and copayments.
Can you have Medicare and Medicaid at the same time?
Yes. People with both Medicare and full Medicaid are called “dually eligible.” The order matters: Medicare pays first for Medicare-covered services, and Medicaid pays last. Dual eligibles are automatically enrolled in a Medicare drug plan, get Extra Help with drug costs, and still choose between Original Medicare and a Medicare Advantage plan. Special Needs Plans and PACE are options for people with both.
In New York, the Medicaid long-term care plans are tied to this. A Medicaid Advantage Plus plan requires both Medicaid and Medicare. PACE is for people 55 and older who need a nursing home level of care. Our PACE vs MLTC guide compares them. One more rule: if you appear eligible for Medicare, the state requires you to apply for it as a condition of Medicaid.
What are QMB, SLMB and QI, and what does New York offer?
These are the Medicare Savings Programs. They are for people with Medicare whose income is too high for full Medicaid but still tight. Medicare.gov lists four federal programs, and the state decides which one you qualify for. Even if you think you won’t qualify, Medicare.gov says to apply.
| Program | What it helps pay | New York 2026 monthly income limit (single / couple) |
|---|---|---|
| Full Medicaid for dual eligibles | Medical care, services and supplies, plus Medicare premiums, coinsurance and deductibles | $1,836 / $2,489. Resources at or below $33,038 / $44,796 |
| QMB (Qualified Medicare Beneficiary) | Part B premium, Part A premium if you pay one, Part A and B deductibles and coinsurance | $1,836 / $2,489 |
| QI (Qualifying Individual) | Part B premium only. Cannot be combined with Medicaid. You must apply every year and approval is first come, first served | $2,474 / $3,355 |
| SLMB (Specified Low-Income) | Federal program that pays the Part B premium | Not listed on New York’s 2026 page. The state decides which program fits you |
The state’s Medicare Savings Program 2026 page adds a $20 monthly deduction when it counts your income, so the practical limits are $20 higher. It gives resource limits only for full Medicaid and lists only income for QMB and QI. QMB and QI members also get Extra Help with drug costs: no more than $12.65 per covered drug in 2026. With QMB, show both your Medicare and Medicaid cards at every visit.
If your income is above these lines but you are close, read our guide to Medicaid spend-down in New York.
Does Medicare or Medicaid pay for home care and nursing homes?
Mostly Medicaid, once the skilled need ends. Medicare covers home health when a person is homebound and needs part-time skilled nursing or therapy, and covers a skilled nursing facility stay for limited days. It does not pay for ongoing help with bathing, dressing, meals, supervision or 24-hour care. Medicare.gov says you may be eligible for that kind of care through Medicaid, or you can buy private long-term care insurance.
In New York, community long-term care usually runs through a Medicaid managed long term care plan. The state’s MLTC page says to enroll you must be assessed as needing community care for more than 120 days and meet the Minimum Needs requirement. For personal care and CDPAP, the state’s CDPAP page describes the same requirement and says PPL is the statewide fiscal intermediary. We walk through eligibility in our CDPAP eligibility guide.
A common question is whether Medicare will pay a relative to care for a parent. It does not. Paying a family caregiver is possible under Medicaid’s CDPAP, with limits on which relatives qualify. See getting paid to care for a parent in New York. For the comparison with facility care, see home care vs nursing home.
How do you apply for Medicare and for Medicaid?
They are two separate applications with two different offices.
- Medicare: sign up through Social Security. The first sign-up window starts 3 months before you turn 65 and ends 3 months after your 65th birthday month. Miss it and you may wait and pay a Part B penalty. Medicare.gov says online at Social Security is the easiest way, using a my Social Security account, or you can call 1-800-772-1213 (TTY 1-800-325-0778). People already getting Social Security benefits before 65 may get Medicare automatically.
- Medicare Savings Program: apply through the state. Apply online with NY State of Health, or send the DOH-4328 application to your local social services office. In New York City that is the Human Resources Administration. The state’s Medicaid Helpline is 1-800-541-2831.
- Medicaid for people 65 and older who are not seeking long-term care. New York says this group, and dual eligibles, now apply through NY State of Health (Marketplace customer service: 1-855-355-5777).
- Medicaid that includes home care, personal care or CDPAP. Apply with your local department of social services. In New York City, the state lists HRA at (718) 557-1399. This route also covers the spend-down program.
- Gather documents. Proof of age, citizenship or immigration status, income, address and your Medicare card. If you are 65 or older and applying for community long-term care or nursing home care, expect to give information on bank accounts, insurance policies and other resources.
- Get free help. HIICAP, New York’s free insurance counseling program, answers Medicare questions at 1-800-701-0501. The state’s how to apply page also points to Facilitated Enrollers who help in person.
Common myths about Medicare and Medicaid
- “Medicare pays for a nursing home.” It pays for skilled care for a limited number of days, and only after a qualifying hospital stay. Long-term custodial care is not covered.
- “If I have Medicare, I can’t get Medicaid.” You can have both. That is what dual eligibility means.
- “Medicare will send an aide to help my parent every day.” A Medicare home health aide is only available while the person also gets skilled nursing or therapy, and it is part-time.
- “My income is too high for Medicaid, so nothing is available.” Medicare Savings Programs have higher income lines, and New York also has a spend-down program.
- “Medicare covers glasses, hearing aids and dentures.” Medicare.gov says it does not cover routine eye exams or hearing aids, and does not cover most dental services.
Which program do we apply for first? Advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
Families often haven’t heard of the Medicare Savings Programs, Extra Help with prescription costs, SNAP, or HEAP for heating bills. Many never check Medicaid or home care eligibility because they assume their income is too high.
If you don’t know what you qualify for, start with what is on the table: insurance, income, benefits already received and the person’s care needs. You don’t have to fill out a dozen applications this week. First find out which programs fit. NYC Aging, NY Connects and Medicaid specialists are good places to ask, and hospital Medical Social Services can help in tricky situations.
Don’t wait for a hospital stay or a fall to start looking at Medicaid and home care programs. It is far easier to arrange safe care before things reach a crisis. For other programs, see our guide to financial help for seniors in NYC.
ProLife Home Care is a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We help families understand their home care options and send them to the right specialist for the rest. Call (718) 232-2777 or use our contact page.
Medicare and Medicaid figures change every year. Everything above was checked on 12 October 2026 against medicare.gov, health.ny.gov and shiphelp.org. Your own eligibility depends on your income, resources and immigration status, so confirm it with Medicaid, Social Security or a HIICAP counselor. This page is general information, not legal or financial advice.
Frequently asked questions
What is the main difference between Medicare and Medicaid?
Medicare is federal health insurance based on age (65 and older) or disability, with no income test. Medicaid is a joint federal and state program based on income and resources, and it pays for nursing home care and personal care that Medicare does not.
Can you have Medicare and Medicaid at the same time?
Yes. People with both are called dual eligible. Medicare pays first for Medicare-covered services, and Medicaid pays last. Depending on the Medicaid level, the state also pays Medicare premiums and may pay deductibles and coinsurance.
Does Medicare or Medicaid pay for a nursing home?
Medicare pays for skilled nursing facility care for up to 100 days per benefit period after a qualifying 3-day hospital stay, with a daily charge from day 21. Medicaid can pay for long-term nursing home care for people who meet its financial and other eligibility rules.
Does Medicaid pay for home care if you have Medicare?
Yes, if you qualify for Medicaid and meet the program’s assessment rules. In New York that usually means personal care, CDPAP or a managed long term care plan, none of which Medicare provides as long-term care.
What is the difference between Medicaid and Medicaid managed care?
Medicaid is the program that decides who is eligible. Managed care means the state works through health plans that arrange the services. For home care, New York’s managed long term care plans arrange community services such as home health aide, personal care and adult day health care.
Do Medicare and Medicaid pay for adult day care?
Medicare does not, because Medicare.gov lists adult day health care as long-term care. New York’s managed long term care program includes adult day health care among its community services for people enrolled in a plan. See our adult day care guide.
What if my income is too high for Medicaid but I struggle with Medicare costs?
Apply for a Medicare Savings Program anyway. QMB covers Part B premiums plus deductibles and coinsurance, and QI covers the Part B premium. If your income is only above the Medicaid line, ask about New York’s spend-down program, and call HIICAP for free counseling.
