Medicare vs Medicaid in New York: Who Each Is For, What It Costs, Where to Apply

What is the difference between Medicare and Medicaid?

The difference is the door you walk through. Medicare is federal coverage tied to age 65 or older, or to a disability; your income does not decide whether you get it. Medicaid is income-based: you qualify because your household income is low enough, at any age, and in New York the rules for some groups also look at assets.

The two also cover different things. Medicaid covers more than any other program in the state: doctor visits, hospital care, prescriptions, labs, mental health and substance use treatment, dental, vision, transportation to appointments in many cases, and long-term care, which no other program here covers. Medicare covers hospital and medical care in parts, and its long-term care coverage is limited to a short rehabilitative nursing stay and short, skilled, doctor-ordered home care.

A common shortcut: Medicare is about how old you are, Medicaid is about how much you earn. Many people with low incomes who are 65 or older qualify for both.

Medicare and Medicaid side by side

Who runs each program?

Medicare is a federal program. You can receive it two ways: Original Medicare, or a Medicare Advantage plan, where a private plan provides your Part A and Part B benefits, generally through a network, and often bundles drug coverage. Part A is hospital insurance, Part B is medical insurance, Part C is Medicare Advantage, and Part D is prescription drug coverage. Advantage vs Original Medicare.

Medicaid in New York runs through the state Department of Health and two application systems. NY State of Health, the state marketplace, handles most people under 65 applying on income. The local department of social services, which in New York City is the Human Resources Administration, handles people 65 and older, disability-based applications and long-term care. Once the application places you, the remaining choice for most people is a Medicaid managed care carrier, and that is a network decision. How Medicaid works in New York.

What does each cost you?

Medicare costs money; Medicaid generally does not. On Medicare you owe the Part B premium, $202.90 a month in 2026 for the standard premium, and a $283 Part B deductible, plus deductibles, coinsurance and copays that depend on how you take your coverage. Plan premiums and cost sharing for Advantage and drug plans are set per plan, per year, so check each one against the notice your plan sends by September 30.

On Medicaid there is no monthly premium and no deductible, which is why a person on Medicare with low income should apply for Medicaid as well: it can pay Medicare premiums and cost sharing.

Two figures are fixed for everyone in 2027. The Part D out-of-pocket cap rises to $2,400, up from $2,100; once you reach it, covered drugs cost nothing for the rest of the year. The largest deductible a standard drug plan may charge rises to $700. The 2027 Part B premium had not been announced when we last checked.

What is dual eligibility?

Dual eligibility means having Medicare and Medicaid at the same time, and it is not a paperwork error. Medicare pays first. Medicaid fills the gaps: premiums, cost sharing, prescriptions through Extra Help, transportation, often dental and vision, and the long-term care Medicare does not cover at all.

People say “dual eligible” for three situations. Full dual eligibility means Medicare plus full Medicaid, the strongest position. QMB means Medicaid pays Medicare premiums and the deductibles, coinsurance and copays, and providers may not bill you for that cost sharing on covered services. QI means Medicaid pays the Part B premium. The two partial levels do not include full Medicaid benefits such as long-term care.

You keep your Medicare arrangement, Original or Advantage, and your doctors do not change because of dual eligibility itself. One caution: it is illegal to sell a Medigap policy to someone the seller knows has Medicaid, except in narrow situations. Medicare and Medicaid together.

How do Medicare Savings Programs fit between the two?

A Medicare Savings Program is the middle ground: Medicaid help with Medicare costs for people whose income is too high for full Medicaid. New York runs two tiers and applies no asset test to either, which is not true in most states.

The first $20 of monthly income is disregarded before the comparison, so apply if you are within $20 of a line. Enrolling in a savings program automatically qualifies you for Extra Help with prescription costs, whatever your savings. SLMB was folded into this two-tier structure when the state expanded the program in 2023.

From October 1, 2026, only citizens, green card holders past or not subject to the five-year bar, Cuban and Haitian entrants and citizens of the Compact of Free Association nations can qualify. Other non-citizens keep Medicaid with state funds but lose the savings program. Medicare Savings Programs in detail.

Where do you apply for each?

Medicare and Medicaid have separate applications, separate calendars and separate offices, and confusing them wastes weeks. First enrollment in Medicare depends on your birthday and on whether you or a spouse still have employer coverage, so get those dates from Medicare directly. People already on Medicare change plans between October 15 and December 7, 2026.

Medicaid takes applications year-round. Use this routing:

The sentence that routes the call: “I have Medicare and I want to apply for Medicaid, a Medicare Savings Program and Extra Help. I am over 65, so should this go through the local department of social services?” Which door is yours.