A quick guide to what each program does, how Medicare's parts fit together, and where long-term care gaps can appear.
Medicare and Medicaid are different public health coverage programs.
Medicare is federal health insurance mainly for people 65 and older and certain younger people with disabilities.
Medicaid is jointly funded by federal and state governments and administered by each state. Some people qualify for both.
Federal health insurance mainly for people 65 and older, plus certain younger people with disabilities or qualifying conditions. Eligibility is not generally based on income.
Health coverage administered by each state within federal rules. Eligibility and benefits depend on the state, eligibility group, income, and sometimes other factors.
A person enrolled in both Medicare and Medicaid. Medicare generally pays first for Medicare-covered services; Medicaid may help with premiums, cost-sharing, and additional benefits under state rules.
Two ways to receive Medicare Part A and Part B benefits.
Part A and Part B through the federal government
A Medicare-approved private plan, also called Part C
Four building blocks that are easy to confuse.
Helps cover inpatient hospital care and certain post-hospital services.
Plain-English reminder: Inpatient hospital care is not the same as long-term custodial care.
Helps cover medically necessary outpatient care and preventive services.
Plain-English reminder: Part B usually has a monthly premium and cost-sharing.
Helps pay for outpatient prescription medications through private plans.
Plain-English reminder: Check every medication and preferred pharmacy during annual enrollment.
Private insurance that helps pay some costs left by Original Medicare.
Plain-English reminder: Enrollment timing can affect whether a policy is available without medical underwriting.
Ongoing help with bathing, dressing, eating, toileting, meals, or supervision is usually custodial care. Medicare may cover limited skilled care when specific rules are met, but not indefinite personal care. Medicaid can cover long-term services and supports for people who qualify, but eligibility, covered services, and delivery systems vary by state.
Estimate a rough yearly out-of-pocket for premiums, deductible, prescriptions, and coinsurance.
Estimate a rough yearly out-of-pocket for premiums, deductible, prescriptions, and coinsurance.
2026 standard is about $202.90. Yours may differ — editable.
2026 estimate is about $283. Editable.
How many fills you expect monthly.
Rough out-of-pocket per fill.
Routine + specialist visits per year.
Approved amount Medicare uses to calculate your 20%.
Typically 20% for Part B.
This is an educational estimate, not a quote. It does not include every possible Medicare, Medicare Advantage, Medigap, Part D, hospital, or long-term care cost.
Your actual cost depends on whether you have Original Medicare, Medicare Advantage (Part C — a private plan alternative for receiving Part A and Part B benefits), or a Medigap supplement. This is a directional estimate, not a quote.
Verifiable, publicly available sources you can explore further.
Official overview of Part A, Part B, Medicare Advantage, and Part D.
Official Medicare premiums, deductibles, coinsurance, and cost-sharing amounts.
Official comparison of provider access, referrals, drug coverage, and plan rules.
Official explanation of how Medicare Supplement insurance works with Original Medicare.
Official Medicare coverage guidance for post-hospital skilled nursing facility care.
Official Medicare coverage guidance for skilled home health services.
Official Medicare coverage guidance for equipment used at home.
Official coverage guidance for long-term and custodial care.
Federal eligibility framework; each state administers its own program within federal rules.
Federal overview of Medicaid long-term services and supports, with state-administered coverage.
CMS resources for coordinating benefits for people enrolled in both programs.
Independent context on Medicare Advantage, Traditional Medicare, supplemental coverage, and dual eligibility.
Independent current context on Medicare Advantage enrollment and plan trends.
Independent overview of Medicaid structure, financing, eligibility, and benefits.