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, or earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS.

Medicaid is a joint federal and state program that covers low-income people of any age. Each state sets its own income limits and decides which groups it will cover. You do not automatically get Medicaid when you turn 65 — you must meet your state's income and asset rules. Some people have both programs at the same time; they are called "dual may be able to access."

The programs pay different things, use different enrollment periods, and have different out-of-pocket costs. Understanding which one you may be able to use — or whether you can use both — depends on your age, income, disability status, and which state you live in.

Key Takeaways

  • Medicare is based on age (65 and older) or disability status; Medicaid is based on income and state rules.
  • You must enroll in Medicare during specific windows or pay a penalty; Medicaid enrollment is usually open year-round in most states.
  • Medicare has premiums, deductibles, and copays; Medicaid costs vary by state but is usually free or low-cost for those who meet income limits.
  • Some people may have access to for both programs and are called "dual may be able to access"; your state Medicaid office can tell you if you are one of them.
  • Social Security, your state Medicaid office, and Medicare.gov are the official places to enroll; do not pay anyone to help you sign up.

How to may have access to for Medicare at 65

You become may be able to access for Medicare the month you turn 65 if you or your spouse paid Medicare taxes while working for at least 10 years (40 quarters). You do not have to be retired. You do not have to be a U.S. citizen, but you must be a permanent resident who has lived in the United States for at least five years.

You must enroll during your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you do not enroll during this window, you will pay a permanent penalty on your Part B premium (the medical insurance part) for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full year you were may be able to access but did not enroll.

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number, birth certificate, and proof of citizenship or permanent residency.

How to may have access to for Medicare before 65 through disability

You can get Medicare at any age if you have been receiving SSDI for 24 months. SSDI is a Social Security program for people who cannot work because of a medical condition expected to last at least 12 months or result in death. You apply for SSDI through Social Security, not through Medicare.

Once you have been on SSDI for two years, Medicare enrollment happens automatically — you do not have to do anything. Your coverage begins the first day of the 25th month of your SSDI award. If you want coverage to start sooner, you can enroll during your Initial Enrollment Period, which is the same seven-month window as for people turning 65.

You can also get Medicare if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). For ESRD, you become may be able to access the month dialysis begins or the month you have a kidney transplant, whichever comes first. For ALS, you become may be able to access the month you are diagnosed. You enroll through Medicare.gov or by calling 1-800-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 (FPL) as a starting point. For 2024, the FPL for a single person is about $14,600 per year; for a family of four, about $30,000. Your state may cover people at 100 percent of FPL, 138 percent of FPL, or a different threshold — there is no single national rule.

Some states expanded Medicaid in 2014 and now cover adults earning up to 138 percent of FPL with no other restrictions. Other states did not expand and cover only certain groups — typically children, pregnant people, parents of young children, elderly people, and people with disabilities. Your state Medicaid office website will show your state's current income limits and covered groups.

Income includes wages, self-employment income, Social Security, pensions, and unemployment benefits. Some states count only gross income; others subtract certain expenses. Assets (savings, property, vehicles) may also count, but rules vary widely. Contact your state Medicaid office or use the AARP Medicaid Calculator to estimate whether you may may have access to in your state.

How to may have access to for Medicaid as a senior or person with a disability

If you are 65 or older or have a disability, you may may have access to for Medicaid even if your income is higher than the standard limit in your state. This is because most states have separate income thresholds for seniors and people with disabilities — often higher than the threshold for working-age adults without disabilities.

You may also may have access to through Supplemental Security Income (SSI), a federal program for people 65 and older, blind, or disabled with very low income and assets. If you receive SSI, you automatically may have access to for Medicaid in most states. SSI income limits are about $943 per month for an individual (2024); asset limits are $2,000 for an individual and $3,000 for a couple.

If you do not receive SSI but are 65 or disabled, your state may use Section 1619(b) rules, which allow you to keep working and earn more than the usual SSI limit while staying on Medicaid. Ask your state Medicaid office whether you may have access to under these higher thresholds.

What happens if you have both Medicare and Medicaid

If you may have access to for both programs, you are dual may be able to access. Medicare is your primary insurance and pays first. Medicaid pays your Medicare premiums, deductibles, and copays — this is called Medicare Savings Program (MSP) coverage. You do not pay anything out of pocket for most services.

To get MSP coverage, you must be enrolled in both Medicare and Medicaid. You do not apply separately for MSP; your state Medicaid office determines whether you may have access to when you apply for Medicaid. Some states automatically enroll you; others require you to ask. Contact your state Medicaid office to confirm you are enrolled in MSP.

If you are dual may be able to access, you may also may have access to for Extra Help, a federal program that covers Medicare prescription drug costs. Extra Help is automatic if you receive SSI or are enrolled in MSP, but you can also apply separately through Social Security.

Enrollment periods and deadlines for each program

Medicare has strict enrollment periods. Your Initial Enrollment Period is seven months centered on your 65th birthday (or the month you become may be able to access through disability). If you miss this window, you can enroll during the General Enrollment Period from January 1 to March 31 each year, but you will pay a permanent penalty. If you have employer coverage or are still working, you may have a Special Enrollment Period that lets you enroll without penalty — ask your employer or call 1-800-MEDICARE.

Medicaid enrollment is usually open year-round in most states. You can apply any month. However, some states have waiting lists for certain services (like home and community-based services for people with disabilities), so applying early matters even though there is no deadline. During the COVID-19 pandemic, states paused disenrollment; that pause ended in most states by mid-2023, so if your Medicaid coverage ended, you may need to reapply.

To enroll in Medicaid, contact your state Medicaid office, your county social services department, or use your state's online portal. You can also call 211 to find your local office. You will need proof of income (recent pay stubs, tax returns, or benefit statements), proof of residency, and proof of citizenship or immigration status.

Frequently Asked Questions

Do I have to be a U.S. citizen to get Medicare or Medicaid?

For Medicare: You must be a permanent resident who has lived in the United States for at least five years. U.S. citizenship is not required. For Medicaid: Rules vary by state. Most states require U.S. citizenship or may have access to immigrant status. Some states cover undocumented immigrants for emergency services only. Contact your state Medicaid office to learn your state's rules.

What if I am still working at 65 — do I have to enroll in Medicare?

If you or your spouse have employer health coverage through your job, you can delay Medicare Part B without penalty as long as you are actively employed and covered. You must enroll within eight months of leaving your job or losing coverage, or you will pay a penalty. Tell your employer's benefits office that you are delaying Medicare so they document this correctly.

Can I get Medicaid if I own a house or car?

Most states do not count your primary home or one vehicle against Medicaid asset limits. However, rules vary. Some states have no asset limit at all; others count second homes or vehicles worth more than a certain amount. Contact your state Medicaid office to learn what assets count in your state.

What if my income is too high for Medicaid but too low for Medicare premiums?

You may may have access to for Low-Income Subsidy (LIS) or Extra Help, which covers Medicare prescription drug costs. You may also may have access to for Medicare Savings Program if your income is slightly above Medicaid limits but still low. These programs have their own income thresholds, usually higher than Medicaid. Call 1-800-MEDICARE or visit Medicare.gov to check whether you may have access to.

How do I know if my state expanded Medicaid?

Visit your state Medicaid office website or call your state's Medicaid hotline. You can also visit the Kaiser Family Foundation's State Health Facts website, which shows which states expanded Medicaid and what income limits apply. If your state did not expand, you may still may have access to if you are in a covered group like children, pregnant people, elderly people, or people with disabilities.