Key Takeaways
- Medicare mostly depends on age or disability. Medicaid depends on income, resources, and state rules.
- Medicare is federal. Medicaid is run jointly by the federal government and each state.
- In 2026, the standard Medicare Part B premium is $202.90 a month.
- Michigan adults ages 19 to 64 may qualify for the Healthy Michigan Plan if income is at or below 133% of the poverty level and they do not have Medicare.
- You can have both programs, and a Berrien Connection navigator in Benton Harbor can help you apply for healthcare programs.
Medicare vs Medicaid comes down to who each program serves. Medicare is federal health insurance. It serves people 65 and older, some younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or ALS. Medicaid is a joint federal and state program that helps pay medical costs for people with limited income. Some people qualify for both.
This guide compares the two programs side by side for Berrien County readers. It also explains Michigan’s Healthy Michigan Plan, what changes if you qualify for both, and where to get free help in Benton Harbor.
Medicare vs Medicaid: What Is the Difference?
The main difference is how you qualify. Medicare depends mostly on age or disability. Medicaid depends on income, resources, and your state’s rules.
| Feature | Medicare | Medicaid |
|---|---|---|
| Who it serves | People 65 or older, some people under 65 with disabilities, and people with ESRD or ALS | People with limited income and resources who meet other rules |
| Who runs it | The federal government. Private companies offer Part C and Part D plans | The federal and state governments together |
| How you qualify | Mostly by age or disability | By income, resources, and your state’s rules |
| What it covers | Hospital care, doctor care, and drug coverage | Doctor visits, hospital stays, and often long-term care that Medicare does not cover |
| What it costs | Premiums, deductibles, and cost sharing | Set by each state. Small co-pays may apply |
Medicare vs Medicaid Eligibility: Who Qualifies for Medicare?
You qualify for Medicare at 65 or older. You may also qualify under 65 with a disability, ESRD, or ALS. Most people do not pay a premium for Part A. That is because they or a spouse paid Medicare taxes long enough.
If you are turning 65, timing matters. Your Initial Enrollment Period lasts 7 months. It starts 3 months before you turn 65 and ends 3 months after the month you turn 65. Medicare.gov explains when coverage starts, and the FAQ below covers late sign-up.
The Centers for Medicare & Medicaid Services (CMS) set these 2026 costs. They change each year, so check for updates.
| 2026 Medicare cost | Amount |
|---|---|
| Part A premium | $0 for most people (about 99%) |
| Part B standard monthly premium | $202.90 |
| Part B yearly deductible | $283 |
| Part A inpatient hospital deductible | $1,736 |
What Do Medicare Parts A and B Cover?
Original Medicare has two parts: hospital insurance (Part A) and medical insurance (Part B).
- Part A covers inpatient hospital care, skilled nursing facility care, hospice, and home health care. It does not cover custodial or long-term care.
- Part B covers medically necessary doctor and provider services, outpatient care, home health care, durable medical equipment, and preventive services.
Medicare also has Part C, called Medicare Advantage, and Part D for prescription drugs. Original Medicare covers most costs, but not all of them.
Who Qualifies for Medicaid in Michigan?
Each state sets its own Medicaid rules. In Michigan, you apply through MI Bridges. Medicare.gov lists these groups: people 65 or older, children under 19, pregnant people, people with disabilities, and parents or adults who care for a child. Many states also cover adults without dependent children.
Michigan’s adult program is the Healthy Michigan Plan. The Healthy Michigan Plan page lists these rules:
- Age: 19 to 64 years old.
- Income: at or below 133% of the federal poverty level.
- Medicare: you do not qualify for it and are not enrolled in it.
- Other Medicaid: you do not qualify for it and are not enrolled in it.
- Pregnancy: you are not pregnant when you apply.
- Residency: you live in Michigan.
You can apply through MI Bridges. You can also call the Michigan Health Care Helpline at 1-855-789-5610 or visit your local MDHHS county office. Some members pay co-pays when a provider charges one. Michigan also lists new work requirements that begin January 1, 2027, so ask MDHHS how they apply to you.
What Does Medicaid Cover That Medicare Does Not?
Medicaid often pays for long-term and daily care that Medicare covers only in part, or not at all. Medicare.gov lists nursing home care, personal care, rides to medical visits, and home- and community-based services. It also lists dental, vision, and hearing care.
Medicaid can also cover doctor visits, hospital stays, mental health care, pregnancy care, and needed medicines. Benefits vary by state, so confirm what Michigan covers for your group.
Can You Have Both Medicare and Medicaid?
Yes. People who have both are called dual eligible. With Medicare and full Medicaid, most of your health care costs are likely covered.
Part D covers prescription drugs for people with Medicare, full Medicaid, or both. Medicaid may still pay for some drugs and other care that Medicare does not. The rules for each program differ. So ask your Medicare plan and MDHHS how they work together for you.
How Can You Decide What to Do Next?
When you weigh Medicare vs Medicaid, start with the program that fits your situation, then check the other one. Use this short checklist.
- Look at Medicare first if you are near 65 or have a disability.
- Check Medicaid through MI Bridges when your income is limited.
- Ask how the two programs work together if you may qualify for both.
- Gather your photo ID, proof of income, and any Medicare card you have.
- Ask for help early, since forms and due dates can be confusing.
Where Can You Get Help With Medicare and Medicaid in Berrien County?
You do not have to sort this out alone. Berrien County residents can start in three places.
- Berrien Connection. A Community Navigator can help you apply for healthcare programs and gather your documents. Visit us at 100 West Main Street in Benton Harbor, Monday to Friday, 9 a.m. to 5 p.m. Walk-ins are welcome, and appointments are recommended. Learn more about our Community Navigator service, or contact our team. Meeting with a navigator is free for Berrien County residents, and no referral is needed.
- MI Bridges. Apply for Medicaid online through MI Bridges.
- Michigan Health Care Helpline. Call 1-855-789-5610 to ask about the Healthy Michigan Plan, or visit your local MDHHS county office.
Frequently Asked Questions About Medicare vs Medicaid
What is Medigap?
Medigap is extra insurance sold by private companies. It can help pay some costs that Original Medicare leaves out, such as copayments, coinsurance, and deductibles. It is a private policy that you buy in addition to Original Medicare, so compare plans before you buy.
Is Medicare Advantage the same as Original Medicare?
No. Medicare Advantage is a private, Medicare-approved plan that usually bundles Parts A, B, and D. It may have lower out-of-pocket costs and may add benefits such as vision, hearing, and dental. Compare costs and covered doctors before you pick a plan.
What happens to Medicaid when I turn 65?
Most people can join Medicare at 65. The Healthy Michigan Plan is for people who do not qualify for or have Medicare, so your coverage may change. You may still qualify for other Medicaid help if your income and resources are limited. Contact MDHHS before you drop or change any coverage.
When can I sign up for Medicare?
Your Initial Enrollment Period lasts 7 months. It starts 3 months before you turn 65 and ends 3 months after the month you turn 65. Coverage always starts on the first of a month. Signing up before your birthday month starts coverage in your birthday month.
What happens if I sign up for Medicare late?
If you miss your Initial Enrollment Period, you may have to wait to sign up. You may also pay a monthly late enrollment penalty for as long as you have Part B. Medicare.gov says the penalty goes up the longer you wait.
How much does Medicare Part B cost in 2026?
The standard Part B premium is $202.90 a month in 2026, and the yearly Part B deductible is $283. Most people, about 99%, pay no premium for Part A. These amounts change each year, so check Medicare.gov.
How do I apply for Medicaid in Michigan?
Apply through MI Bridges, call the Michigan Health Care Helpline at 1-855-789-5610, or visit your local MDHHS county office. Have your photo ID and proof of income ready. A Berrien Connection navigator can help you gather documents.
Does Michigan Medicaid have a work requirement?
Michigan says Healthy Michigan Plan work requirements begin January 1, 2027. Medicaid.gov says some adults may need 80 hours a month of work, community service, job training, or school. Some groups are exempt. Ask MDHHS whether the rule applies to you.
Related Guides From Berrien Connection
- Food Stamp Phone: Get Low-Cost Phone Service With SNAP: Medicaid can also qualify you for a Lifeline phone discount.
- Community Service Ideas in Berrien County: Easy Ways to Help: Community service may count toward Medicaid work requirements starting in 2027.
Need help applying for healthcare programs? Meet a Community Navigator for free, one-on-one support in Benton Harbor.
About this guide. Berrien Connection is a nonprofit in Benton Harbor, Michigan. We checked this guide against the official pages listed below on October 29, 2026. It is general information, not medical, legal, or financial advice. Costs and rules change each year, so confirm details with Medicare.gov and MDHHS. The photos in this guide are illustrative.
Sources
- Medicare.gov: What are Medicare & Medicaid? (PDF)
- Medicare.gov: When does Medicare coverage start?
- CMS: 2026 Medicare Parts A and B Premiums and Deductibles
- Michigan: Healthy Michigan Plan
- Medicaid.gov: Healthy Michigan Plan Eligibility Changes
- MI Bridges
- Berrien Connection: Social Navigation
- Berrien Connection: Contact