You can hold both Medicare and Medicaid, and the process for each is separate

Medicare is a federal health insurance program for people 65 and older, regardless of income. Medicaid is a joint federal-state program for people with lower incomes, and may be able to access rules vary by state. You do not choose one or the other — you can have both at the same time. People who may have access to for both are sometimes called "dual may be able to access."

The enrollment paths are different. Medicare enrollment happens through Social Security or Medicare.gov. Medicaid enrollment happens through your state's Medicaid office or marketplace. Starting Medicare at 65 does not automatically enroll you in Medicaid, and vice versa. You must take action for each program separately.

Key Takeaways

  • Medicare enrollment at 65 is automatic if you are already receiving Social Security, but you must sign up manually if you are not yet taking benefits.
  • Medicaid enrollment depends entirely on your state's rules and income limits, which differ significantly from state to state.
  • You can hold both programs at the same time, and Medicaid often covers costs that Medicare does not, like long-term care and dental.
  • Missing Medicare's initial enrollment window can result in permanent late penalties, so timing matters for Medicare but not for Medicaid.
  • Your state's Medicaid office or 211 can tell you whether you meet your state's income and asset limits before you spend time on paperwork.

How Medicare enrollment works at 65

If you are already receiving Social Security retirement benefits when you turn 65, Medicare Part A (hospital insurance) and Part B (medical insurance) enroll automatically. You will receive your Medicare card in the mail about three months before your 65th birthday. You do not need to do anything.

If you are not yet taking Social Security at 65, you must enroll in Medicare yourself. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The enrollment window is three months before your 65th birthday, your birth month, and three months after. If you miss this window and do not have a may have access to reason (such as employer coverage), you will pay a permanent 10% penalty on Part B premiums for as long as you have Medicare.

Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years. Part B has a monthly premium, which varies by income. Part D (prescription drug coverage) is optional but recommended; if you go without it and later enroll, you pay a penalty based on how long you waited.

How Medicaid enrollment works in your state

Medicaid rules are set by each state, so income limits, asset limits, and what the program covers differ where you live. Some states expanded Medicaid to cover adults earning up to 138% of the federal poverty line; others did not. A person who qualifies for Medicaid in one state may not in another.

To find out whether you may be covered, contact your state's Medicaid office directly or call 211 and ask for Medicaid information. They can tell you your state's income and asset limits in one call. If you think you may have access to, you can enroll through your state's Medicaid office, your state's health insurance marketplace, or sometimes through a local community health center.

Medicaid enrollment does not have a deadline or penalty for late enrollment. You can enroll at any time during the year. Processing usually takes two to four weeks, though some states are faster.

What happens when you have both programs

When you have both Medicare and Medicaid, Medicare is your primary insurance and pays first. Medicaid is secondary and covers some costs Medicare does not. This combination is especially valuable because Medicare has gaps: it does not cover dental, vision, hearing aids, or long-term nursing home care. Medicaid often does.

If you have both programs, Medicaid typically covers your Medicare premiums, deductibles, and copayments. This is called "cost-sharing." Medicaid may also cover services Medicare does not, such as transportation to medical appointments or personal care assistance at home.

You will receive two insurance cards: one from Medicare and one from Medicaid. When you see a doctor, show both. The provider will bill Medicare first, then send the remaining balance to Medicaid.

Income and asset limits vary by state

Medicaid has income limits, but they differ by state and by category. Most states use the federal poverty line as a starting point, but some states set limits higher or lower. A few states have different limits for elderly people than for working-age adults.

Medicaid also has asset limits in most states, meaning you can own only a certain amount of money, property, or other resources. The limit varies by state — some states have no asset limit at all. Your home and one vehicle are usually not counted. Your spouse's income and assets may or may not count, depending on your state's rules.

Because these rules are complex and state-specific, the fastest way to know whether you may have access to is to call your state's Medicaid office or 211 and give them your income and assets. They will tell you in minutes whether you meet the threshold.

Documents you will need for each program

For Medicare, you will need your Social Security number. If you are signing up by phone or online, that is usually all you need. If you are signing up in person at a Social Security office, bring a photo ID and proof of citizenship (such as a birth certificate or passport).

For Medicaid, requirements vary by state, but most ask for proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or legal residency, and proof of your state residency. Some states ask for asset documentation as well. Your state's Medicaid office can tell you exactly what to bring before you apply.

What to do if you are already 65 and do not have Medicare

If you are 65 or older and never enrolled in Medicare, you can still enroll, but you may owe back premiums and penalties. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to enroll now. Explain that you missed the initial enrollment window; Medicare may waive the penalty if you have a may have access to reason, such as employer coverage or a disability.

If you are already on Medicaid and turn 65, contact your state's Medicaid office to let them know. Your Medicaid coverage may change when Medicare starts, because Medicaid rules for people over 65 are sometimes different from rules for working-age adults. Your state will tell you what happens next.

Frequently Asked Questions

Does turning 65 automatically put me on Medicaid?

No. Medicare and Medicaid are separate programs. Turning 65 enrolls you in Medicare only if you are already taking Social Security. Medicaid enrollment depends on your state's income and asset limits, which have nothing to do with age. You must enroll in Medicaid separately through your state's Medicaid office.

What if my state did not expand Medicaid?

In states that did not expand Medicaid, the income limit for adults is much lower — often around 40% of the federal poverty line. If you do not may have access to under your state's rules, you may be able to purchase coverage through your state's health insurance marketplace instead. Call 211 or visit Healthcare.gov to explore other options.

Can I enroll in Medicaid after I turn 65?

Yes. Medicaid has no age deadline. You can enroll at any time. However, some states have different Medicaid rules for people over 65 than for younger adults, so contact your state's Medicaid office to confirm what coverage looks like at your age and income level.

What if I miss Medicare's enrollment deadline?

You can still enroll, but you may owe a permanent 10% penalty on Part B premiums. Contact Medicare at 1-800-MEDICARE to enroll and explain your situation. If you have a may have access to reason — such as employer coverage or a disability — Medicare may waive the penalty.

Do I need to enroll in Part D if I have Medicaid?

It depends on your state. Some states cover prescription drugs through Medicaid; others require you to enroll in Part D. Contact your state's Medicaid office or call 211 to find out what your state covers. If your state requires Part D and you do not enroll, you will pay a penalty.