Medicare vs Medicaid — what's the difference?

They sound nearly identical, get confused constantly, and a lot of people qualify for both. Here's the short version.

Medicare

Federal program that covers most people 65 or older, plus some younger people with qualifying disabilities or ESRD/ALS. Run by CMS (Centers for Medicare and Medicaid Services). Eligibility is mostly age-based, not income-based.

Part A — hospital. Free for most.
Part B — doctors, outpatient. ~$206.50/mo in 2026.
Part C / MA — Medicare Advantage, private alternative.
Part D — prescription drugs.

Medicaid

Joint federal-state program for low-income people. Each state runs it differently. In Wisconsin, the consumer-facing brand is BadgerCare Plus for most adults and kids, with separate pathways for elderly / disabled (EBD, Medicaid SSI), long-term care (Family Care, IRIS), and seniors needing Rx help (SeniorCare).

Income-based eligibility, with asset tests on some pathways.
Year-round enrollment — not tied to AEP windows.
WI applications go through ACCESS at access.wisconsin.gov.
Wisconsin did NOT expand Medicaid under the ACA. Adults 100–138% FPL go to the Marketplace instead.

Quick eligibility check

1
Are you 65 or older, or have you been on disability for 24+ months? If yes, you likely qualify for Medicare regardless of income.
2
Is your household income below ~$22,000 single / $45,000 family of four? You may qualify for BadgerCare or another WI Medicaid program.
3
Both?You're “dual-eligible” and likely qualify for a D-SNP — a Medicare Advantage plan designed for people with both. Usually $0 premium and richer extras.

Dual-eligibles: don't leave money on the table

~6 million Americans qualify for a Medicare Savings Program but aren't enrolled. MSP pays your Part B premium ($2,478/yr in 2026); LIS waives your Part D deductible ($615) and caps drug copays. Worth checking before you pick a plan.

Run the WI Medicaid screener

Common confusions

“I have Medicare, so I don't need anything else, right?”: Original Medicare covers ~80% of approved services and has no out-of-pocket cap. Most people add either a Medigap + Part D combo or a Medicare Advantage plan to fill the gaps. If you're low-income, a D-SNP may cover almost everything.
“I'm on BadgerCare and turning 65 — do I lose it?”: Not automatically. Your BadgerCare for adults usually ends when you become Medicare-eligible, but you may transition to Medicaid SSI, EBD, or a Medicare Savings Program based on income. The screener checks all three.
“Medicaid covers everything Medicare doesn't, right?”: For full duals (Medicaid + Medicare), mostly yes — Medicaid picks up Medicare premiums, deductibles, and coinsurance, plus benefits Medicare doesn't cover (long-term care, most dental). For partial duals (just MSP), Medicaid only covers the items the specific MSP tier authorizes.

Confused about which one applies to you? The Wisconsin SHIP Medigap Helpline at 1-800-242-1060 will walk you through your specific situation, free.