Medicare and Medicaid are separate programs with different enrollment paths

Medicare is a federal health insurance program for people age 65 and older, regardless of income. You become may be able to access automatically when you turn 65 if you have worked and paid Social Security taxes for at least 10 years. Medicaid is a joint federal-state program for people with lower incomes, and enrollment rules vary by state. You cannot hold both programs at the same time — if you may have access to for Medicare, Medicaid becomes your secondary coverage and only pays costs Medicare does not cover.

The enrollment process depends on which program you need. Medicare enrollment happens through Social Security or Medicare.gov. Medicaid enrollment happens through your state's Medicaid office or health insurance marketplace. Missing Medicare's enrollment deadlines can result in permanent penalties on your premiums, so timing matters.

Key Takeaways

  • Medicare enrollment begins three months before you turn 65 and ends three months after; missing this window triggers a lifetime penalty unless you have employer coverage or other may have access to circumstances.
  • You can enroll in Medicare by calling Social Security at 1-800-772-1213, visiting your local Social Security office, or going to Medicare.gov.
  • Medicaid enrollment happens through your state's Medicaid office or the health insurance marketplace, and income limits and covered services differ by state.
  • If you receive Social Security benefits, Medicare Part A and Part B are enrolled automatically at 65, but you must choose Part D (prescription drug coverage) yourself or face a penalty.
  • Some people may have access to for both programs; Medicaid covers Medicare premiums and cost-sharing for those who meet income and asset limits.

How Medicare enrollment works and when to enroll

Medicare enrollment is tied to your 65th birthday and happens in a seven-month window: three months before you turn 65, the month you turn 65, and three months after. This is called your Initial Enrollment Period. If you enroll during this window, your coverage starts on the first day of the month you turn 65 (or the first day of the following month if you enroll in that month).

If you miss this window and do not have employer coverage or other may have access to circumstances, you pay a permanent 10 percent increase to your Part B premium for as long as you have Medicare. The same applies to Part D (prescription drug coverage) — if you go 63 days or more without drug coverage, you pay a penalty when you finally enroll. These penalties do not go away.

You can enroll by calling Social Security at 1-800-772-1213, visiting your local Social Security office in person, or going to Medicare.gov and creating an account. If you already receive Social Security benefits, Medicare Part A (hospital insurance) and Part B (medical insurance) are enrolled automatically at 65, but you still need to choose Part D coverage yourself.

Understanding Medicare Parts A, B, D, and supplemental coverage

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people do not pay a premium for Part A because they paid Medicare taxes while working. Part B covers doctor visits, outpatient care, and medical equipment. Part B has a monthly premium (the amount changes yearly) and a yearly deductible you pay before coverage begins.

Part D is prescription drug coverage offered by private insurance companies approved by Medicare. You choose a plan during enrollment, and the plans vary in which drugs they cover and what you pay. If you do not choose a plan during your Initial Enrollment Period, you pay a penalty when you enroll later.

Many people also buy Medigap (supplemental insurance) to cover costs that Medicare does not pay, such as copayments and coinsurance. Medigap is sold by private insurance companies and has its own enrollment rules and premiums. You can also choose Medicare Advantage (Part C) instead of Original Medicare plus Medigap — this is an all-in-one plan offered by private insurers that covers Parts A, B, and usually D.

How Medicaid enrollment works by state

Medicaid enrollment rules and income limits are set by each state, so the process differs depending on where you live. Some states use the federal health insurance marketplace (Healthcare.gov), while others use their own Medicaid websites. A few states have not expanded Medicaid under the Affordable Care Act, which means fewer people may have access to.

To find your state's Medicaid office, visit Medicaid.gov and select your state, or call 1-800-MEDICARE and ask for a referral. You can also call 211 (a free helpline) and ask for your local Medicaid office. When you contact them, have your Social Security number, proof of income (recent pay stubs or tax returns), and proof of citizenship or immigration status ready.

Medicaid covers more services than Medicare in most states — including dental, vision, hearing aids, and long-term care — but you must meet income and asset limits. If you are over 65 and have low income, you may may have access to for both Medicare and Medicaid. In that case, Medicaid can pay your Medicare premiums and help cover out-of-pocket costs.

Medicaid for people over 65 with low income

If you are 65 or older and your income is below your state's limit, you can enroll in Medicaid even if you already have Medicare. This is sometimes called dual may be able to access status. Medicaid becomes your secondary insurance and pays costs that Medicare does not cover, including Medicare premiums, deductibles, and copayments.

Income limits for seniors vary by state but are generally around 100 to 135 percent of the federal poverty level. Some states also count assets (savings, investments, property other than your home), while others do not. Contact your state Medicaid office to learn the exact limits and what counts as income or assets in your state.

If you may have access to for both programs, you do not need to choose between them — you are automatically enrolled in both once you meet the requirements. However, you still need to enroll in Medicare Part D yourself, because Medicaid does not automatically cover prescription drugs.

Special enrollment periods if you miss the deadline

If you miss Medicare's Initial Enrollment Period, you may still enroll without a penalty if you have a may have access to life event. These include losing employer coverage, moving to a new state, or experiencing a significant change in income. You have 63 days from the may have access to event to enroll.

For Medicaid, most states allow year-round enrollment, so there is no strict deadline. However, some states have closed their Medicaid programs temporarily due to funding, so contact your state office to confirm the program is currently open before you begin the enrollment process.

If you are still working at 65 and your employer offers health insurance, you may be able to delay Medicare enrollment without penalty. This is called the Special Enrollment Period for employer coverage. You can enroll in Medicare later when you leave your job or lose the employer coverage, as long as you enroll within 63 days of the coverage ending.

Documents you need to enroll

For Medicare enrollment, you need your Social Security number and proof of citizenship or legal residency (a birth certificate, passport, or naturalization papers). If you are enrolling by phone or in person at a Social Security office, you can provide these verbally, but if you enroll online at Medicare.gov, you may need to upload documents.

For Medicaid enrollment, requirements vary by state, but generally you need proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, and proof of your state residency. Some states also ask for proof of assets. Your state Medicaid office will tell you exactly what to bring when you contact them.

What happens after you enroll

After you enroll in Medicare, you receive a Medicare card in the mail within two weeks. Your coverage begins on the first day of the month you turn 65 (or the first day of the following month if you enroll after your birthday month). You can start using your card immediately once you receive it.

After you enroll in Medicaid, your state sends you a Medicaid card or information about how to access your coverage online. Coverage typically begins on the first day of the month after you are approved, though some states backdate coverage to the first day of the month you applied. Contact your state Medicaid office to confirm your coverage start date.

Once enrolled, you can use your coverage to see doctors, fill prescriptions, and access other covered services. If you have questions about what is covered or how much you owe, call the number on the back of your card.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Yes, you can enroll starting three months before your 65th birthday. The earliest you can enroll is three months before the month you turn 65. Your coverage will not start until the first day of the month you turn 65 (or the first day of the following month if you enroll after your birthday month).

What if I am still working at 65 and have employer insurance?

You can delay Medicare enrollment without penalty if your employer has 20 or more employees and offers health insurance. You have 63 days after you leave your job or lose the employer coverage to enroll in Medicare without paying a penalty. Tell your employer's benefits office that you are delaying Medicare so they know not to enroll you automatically.

Do I have to choose a Medigap plan when I turn 65?

No, but if you want Medigap coverage, you have the best rates and may provide acceptance if you enroll within six months of turning 65 and enrolling in Medicare Part B. After that window closes, insurance companies can charge you more or deny you coverage based on your health. You can also choose Medicare Advantage instead of Medigap.

What if my state has not expanded Medicaid?

If your state has not expanded Medicaid, you may still may have access to if you are 65 or older, blind, or disabled. Income limits are lower in non-expansion states, but seniors and people with disabilities have separate pathways. Contact your state Medicaid office to learn whether you meet the requirements.

Can I change my Medicare or Medicaid coverage after I enroll?

Yes, during the annual open enrollment period (October 15 to December 7 each year), you can switch Medicare plans, add or drop Part D coverage, or change from Original Medicare to Medicare Advantage. For Medicaid, most states allow changes year-round, but contact your state office to confirm the rules in your area.