Medicare and Medicaid use different rules because they cover different groups of people

Medicare is based on age and work history. You become may be able to access at 65, or earlier if you receive Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS. You do not need to be poor to may have access to — it is available to anyone who meets the age or disability requirement.

Medicaid is based on income and household size. Each state sets its own income limits, so what qualifies you in one state may not in another. Some states also cover people with disabilities or long-term care needs regardless of income. Unlike Medicare, Medicaid is a means-tested program — your financial situation determines whether you get coverage.

The two programs overlap for people 65 and older who have low income. These people are called "dual may be able to access" and receive benefits from both programs at the same time.

Key Takeaways

  • Medicare may be able to access is based on age (65 or older), disability status, or specific medical conditions, and does not depend on income.
  • Medicaid may be able to access is based on income and household size, with limits that vary by state and sometimes by age or disability status.
  • You must be a U.S. citizen or may have access to immigrant to enroll in either program.
  • Medicare enrollment happens through Social Security; Medicaid enrollment happens through your state's Medicaid office or health insurance marketplace.
  • Some people may have access to for both programs simultaneously, which is called dual may be able to access.

Medicare may be able to access: age, disability, and medical conditions

The most common path to Medicare is turning 65. You become may be able to access the month you turn 65, whether you are still working or retired. You do not have to stop working to enroll, but you should sign up during your initial enrollment period — the three months before, the month of, and the three months after your 65th birthday. If you miss this window, you may pay a permanent penalty on your premiums.

You can also may have access to for Medicare before 65 if you have been receiving SSDI for 24 months. This includes people with disabilities of any age. If you receive Supplemental Security Income (SSI) instead of SSDI, you do not automatically may have access to — SSI is a needs-based program separate from SSDI.

A third path is having end-stage renal disease (ESRD) or ALS (amyotrophic lateral sclerosis). People with ESRD become may be able to access immediately upon diagnosis if they need dialysis or a kidney transplant. People with ALS become may be able to access immediately upon diagnosis, without a waiting period.

To enroll in Medicare, you must be a U.S. citizen or a may have access to immigrant who has been in the country for at least five years. You enroll through Social Security — either by calling 1-800-772-1213, visiting your local Social Security office, or applying online at ssa.gov.

Medicaid may be able to access: income limits that vary by state

Medicaid income limits depend on your state and your household size. The federal poverty level is the baseline, but states can set their limits higher or lower. As of 2024, the federal poverty level for a single person is around $14,600 per year, but your state's Medicaid program may cover people earning significantly more or less than this amount.

Most states use "modified adjusted gross income" (MAGI) to calculate your income for Medicaid purposes. MAGI includes wages, self-employment income, and certain other sources, but excludes some items like child support received or certain tribal income. Your state's Medicaid office can tell you exactly what counts toward your income limit.

Beyond income, some states cover people based on disability or age. If you are 65 or older, blind, or disabled, you may may have access to for Medicaid even if your income is above the standard limit in your state. Some states also cover pregnant people and children at higher income levels than they cover adults without children.

To find out your state's specific income limits and rules, contact your state Medicaid office directly. You can also use the Medicaid.gov website to find your state's contact information and learn about coverage categories in your area.

Citizenship and immigration status requirements

Both Medicare and Medicaid require you to be a U.S. citizen or a may have access to immigrant. For Medicare, you must have been a may have access to immigrant for at least five years. For Medicaid, the rules vary by state — some states cover may have access to immigrants immediately, while others have waiting periods or cover only certain categories.

A "may have access to immigrant" includes lawful permanent residents (green card holders), refugees, asylees, and certain other categories defined by federal law. Undocumented immigrants do not may have access to for Medicare or standard Medicaid coverage in most states, though some states offer limited Medicaid coverage for emergency services or pregnancy-related care.

If you are unsure about your immigration status or whether it affects your coverage, ask your state Medicaid office or call 1-800-MEDICARE for Medicare questions. Both can explain how your specific situation affects your options.

How to enroll in Medicare

You enroll in Medicare through Social Security, not through your state. You can apply online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your Social Security number, birth certificate, and proof of citizenship or immigration status.

If you are already receiving Social Security benefits, you are automatically enrolled in Medicare Parts A and B the month you turn 65. You do not need to do anything — your coverage begins automatically. If you are not yet receiving Social Security, you must apply for Medicare separately.

Medicare has different parts: Part A covers hospital care, Part B covers doctor visits and outpatient services, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers. You choose your coverage during your initial enrollment period or during the annual open enrollment period from October 15 to December 7.

How to enroll in Medicaid

You enroll in Medicaid through your state's Medicaid office, not through the federal government. Each state runs its own program with its own rules and enrollment process. You can find your state's Medicaid office through Medicaid.gov or by searching "[your state] Medicaid" online.

In most states, you can also enroll through the Health Insurance Marketplace (healthcare.gov) if you are looking for coverage during open enrollment. The Marketplace will determine whether you may have access to for Medicaid based on your income and household size, and will enroll you directly if you do.

When you apply, you will need to provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, and information about your household size and composition. Processing times vary by state but typically take two to four weeks.

What happens if you miss enrollment deadlines

Missing Medicare's initial enrollment period can cost you. If you do not enroll in Part B during your initial enrollment period and you do not have other may have access to coverage, you will pay a permanent 10% increase on your Part B premium for each year you were may be able to access but not enrolled. This penalty stays with you for life.

Medicaid does not have the same penalty structure because it is ongoing coverage. If you miss enrollment, you can apply at any time and coverage will begin the month you apply (or sometimes the month you are found to be may be able to access, depending on your state). However, some states have specific open enrollment periods for certain types of Medicaid coverage, so it is worth checking your state's rules.

If you have a may have access to life event — such as losing employer coverage, getting married, having a child, or moving to a new state — you may be able to enroll in Medicare or Medicaid outside the normal enrollment periods. Contact Social Security for Medicare or your state Medicaid office for Medicaid to ask about your specific situation.

Frequently Asked Questions

Can I have both Medicare and Medicaid at the same time?

Yes. If you are 65 or older and have low income, you may may have access to for both programs. Medicaid pays some of your Medicare premiums and cost-sharing (copays and deductibles). People with both programs are called "dual may be able to access." Your state Medicaid office can tell you whether you may have access to.

What if my income changes after I enroll in Medicaid?

Report the change to your state Medicaid office as soon as possible. If your income increases above your state's limit, your coverage may end. If your income decreases, you may become may be able to access for additional benefits. The timing of when your coverage changes depends on your state's rules.

Do I have to be retired to get Medicare at 65?

No. You can be working full-time and still enroll in Medicare at 65. Your work status does not affect your may be able to access. However, if you are still working and have employer health insurance, you may want to delay enrolling in Part B to avoid paying for duplicate coverage.

What if I am a green card holder — can I get Medicare or Medicaid?

Yes, if you have been a lawful permanent resident (green card holder) for at least five years. After five years, you may have access to for Medicare at 65 or if you meet the disability requirements. For Medicaid, the waiting period varies by state — some cover green card holders immediately, while others have different rules.

How do I know what my state's Medicaid income limit is?

Visit Medicaid.gov and select your state, or call your state's Medicaid office directly. Income limits change periodically and vary based on household size and composition, so it is worth checking your state's current rules rather than relying on information from previous years.