Medicare and Medicaid are separate programs with different rules

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). You get it based on age or disability status, not income. Most people become may be able to access at 65, but you can may have access to younger if you have been receiving Social Security Disability Insurance (SSDI) for 24 months or have end-stage renal disease or ALS.

Medicaid is a joint federal and state program that covers people based on income and other factors. Each state sets its own income limits and decides which groups it will cover. You do not have to be elderly or disabled to get Medicaid — many working adults and children may have access to.

The two programs overlap in some cases. Some people are covered by both — these people are called "dual may be able to access." But the programs are not the same, they do not use the same income rules, and you do not automatically get one because you have the other.

Key Takeaways

  • Medicare is based on age (usually 65) or disability status and is the same nationwide; Medicaid is based on income and varies by state.
  • You must sign up for Medicare during your enrollment period or pay a penalty; Medicaid enrollment is usually open year-round.
  • Medicare has premiums, deductibles, and copays; Medicaid costs vary by state and may be free or low-cost depending on your income.
  • Some people may have access to for both programs at the same time; your state Medicaid office can tell you if you are one of them.
  • You apply for Medicare through Social Security; you apply for Medicaid through your state or county Medicaid office.

How to may have access to for Medicare based on age

You become may be able to access for Medicare on the first day of the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not need to be retired. If you were born on the first of the month, your coverage starts the month before.

If you are not yet 65 but have been receiving SSDI for 24 months, you become may be able to access automatically — Social Security will enroll you without you having to do anything. If you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis), you can become may be able to access at any age, but you must report the diagnosis to Social Security.

You must sign up during your enrollment period. Your initial enrollment period is the seven-month window that includes the month you turn 65, plus three months before and three months after. If you miss this window and do not have other health coverage, you will owe a late enrollment penalty for as long as you have Medicare.

How to may have access to for Medicaid based on income

Medicaid income limits vary by state and change each year. Most states use the federal poverty level as a starting point, then set their own threshold — some cover people up to 138% of poverty, others up to 100%, and a few go higher or lower. Your state Medicaid office publishes its current income limit each year.

Income includes wages, self-employment income, Social Security, pensions, and some other sources. Some income does not count — for example, the first $65 per month of earned income is often excluded, and some states exclude certain types of support. Your state Medicaid office can tell you which income counts in your case.

Medicaid also looks at resources (savings, property, vehicles) in some states. Federal rules allow you to own a home and a car without losing coverage, but limits on cash savings vary. Some states have no resource limit at all; others cap it at $2,000 for an individual. Check your state's rules before you assume you are over the limit.

Other groups that can get Medicaid without meeting income rules

Many states cover people who do not meet the income limit if they fall into a protected group. These include pregnant people, children under 19, people over 65, people who are blind, and people who are disabled. Some states also cover parents of dependent children, former foster youth, and people with specific diagnoses.

If you are in one of these groups, your state may cover you even if your income is above the regular limit. Some states use a higher income threshold for these groups; others use a different calculation altogether. Your state Medicaid office can tell you whether you fall into a covered group and what the income rule is for that group.

How to apply for Medicare

You apply for Medicare through Social Security. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your birth certificate, proof of citizenship or legal residency, and your W-2 forms or tax return (to prove you paid Medicare taxes).

If you are already receiving Social Security retirement or SSDI benefits, you do not need to do anything — Social Security will enroll you automatically three months before you turn 65. If you are not yet receiving benefits, you should sign up for Medicare at the same time you sign up for retirement benefits.

If you have end-stage renal disease or ALS, contact Social Security as soon as you have a diagnosis. You will need medical documentation from your doctor. Social Security will determine your may be able to access date based on when the condition began.

How to apply for Medicaid

You apply for Medicaid through your state or county Medicaid office, not through a federal agency. The easiest way to find your office is to call 211 or visit your state's Medicaid website — search "[your state] Medicaid" to find the official portal.

Most states now let you apply online through their Medicaid portal. You can also apply by mail, phone, or in person. You will need proof of income (recent pay stubs, tax return, or a letter from your employer), proof of identity, and proof of citizenship or legal residency. If you are applying based on disability, you may need medical records.

Medicaid enrollment is usually open year-round, unlike Medicare. Once you are approved, your coverage usually starts on the first day of the month you applied or the month after, depending on your state. You will receive a Medicaid card in the mail.

What happens if you may have access to for both Medicare and Medicaid

Some people are may be able to access for both programs at the same time. This usually happens when someone is 65 or older and has low income, or when someone is disabled, receives SSDI, and has low income. These people are called "dual may be able to access."

If you are dual may be able to access, Medicare is your primary insurance — it pays first. Medicaid pays some of your Medicare costs (premiums, deductibles, copays) and covers services Medicare does not cover. Your state Medicaid office determines what Medicaid will pay for you based on your income and your state's rules.

You do not have to do anything special to coordinate the two programs. Once you are enrolled in both, the programs communicate with each other. However, you should tell your Medicaid office that you have Medicare, and tell Medicare that you have Medicaid, so both have accurate information.

Frequently Asked Questions

Can I get Medicare before I turn 65?

Yes, if you have been receiving SSDI for 24 months, if you have end-stage renal disease, or if you have ALS. Otherwise, you must wait until 65. If you are under 65 and do not have Medicare, you may be able to get Medicaid based on your income and disability status.

What if my state did not expand Medicaid?

Some states have not expanded Medicaid to cover adults earning up to 138% of poverty. In those states, the income limit for adults without dependent children is much lower — sometimes 0% of poverty, meaning you must have almost no income. You can still look into whether you fall into a protected group (pregnant, disabled, over 65) that has a higher limit.

Do I have to pay for Medicare?

Medicare Part A (hospital insurance) is free if you or your spouse paid Medicare taxes for at least 10 years. Parts B (doctor visits) and D (prescription drugs) have monthly premiums. Medicaid costs vary by state — some states charge nothing; others charge small copays or premiums based on income.

What if I miss the Medicare enrollment deadline?

If you miss your initial enrollment period and do not have other health coverage, you will owe a late enrollment penalty. The penalty is 10% of the Part B premium for each full 12-month period you were not enrolled. You can still enroll during the general enrollment period (January 1 to March 31 each year), but the penalty applies.

Can I apply for Medicaid if I am working?

Yes. Many working people may have access to for Medicaid based on income. Some states have special programs for working people with disabilities. Your state Medicaid office can tell you whether your income and work status make you may be able to access.