Yes, Medicaid covers elderly people, but Medicare usually comes first

Medicaid does cover people aged 65 and older, but it is not the main health insurance program for that age group. Medicare is the federal program that covers nearly all Americans at 65. Medicaid is a joint federal-state program that covers low-income people of any age, including seniors who do not have enough money or assets to pay for care.

The key difference: Medicare is based on age. Medicaid is based on income and assets. An elderly person might have both programs at the same time — this is called being "dual may be able to access." They might have only Medicare. Or, if they are poor enough and their state runs a generous Medicaid program, they might have only Medicaid. The rules vary significantly by state.

Key Takeaways

  • Medicaid for elderly people exists in every state but covers only those whose income and assets fall below their state's limits, which vary widely.
  • Most people over 65 have Medicare first, and Medicaid acts as a secondary payer for costs Medicare does not cover, such as nursing home care and long-term services.
  • Medicaid is the only program that pays for extended nursing home stays and in-home care for elderly people with low income, which Medicare does not cover.
  • Each state sets its own income and asset limits for elderly Medicaid, so you must check your specific state's rules to know whether you may be covered.
  • Applying for Medicaid as an elderly person usually happens through your state's Medicaid office, often called the Department of Human Services or Department of Social Services.

Income and asset limits for elderly Medicaid vary by state

There is no single national income limit for Medicaid for people over 65. Each state sets its own threshold. Some states use the federal poverty line as a reference point; others set limits higher or lower. Some states have separate programs for elderly people; others fold them into the general Medicaid program.

As of 2024, most states allow elderly people to have a monthly income between $900 and $1,500 and still be covered, but this varies. Some states are more restrictive. A few states have higher limits. You cannot know whether you may have access to without checking your state's specific numbers.

Asset limits also differ by state. Many states allow an elderly person to own a home (which does not count against the limit) plus a small amount of cash or savings — often between $2,000 and $4,000 for a single person. But again, your state may be different. Some states count vehicles; others do not. Some count life insurance; others do not.

What Medicaid covers for elderly people

For elderly people who have both Medicare and Medicaid, Medicaid typically pays the costs that Medicare does not cover. This includes Medicare premiums, deductibles, and copayments. Medicaid also covers services Medicare does not pay for at all, such as long-term nursing home care, assisted living, and in-home personal care services.

For elderly people who have only Medicaid (because they do not yet may have access to for Medicare or have not signed up), Medicaid covers hospital stays, doctor visits, prescription drugs, and other medical services, though the scope varies by state.

The most important coverage for many elderly people is long-term care. Medicaid is the only major program that pays for nursing home stays lasting months or years. Medicare covers only the first 100 days of skilled nursing care under strict conditions, and only if you were hospitalized first. After that, you pay out of pocket unless Medicaid covers you.

How to apply for Medicaid as an elderly person

You apply through your state's Medicaid office. The office may be called the Department of Human Services, Department of Social Services, Department of Medical Assistance, or something similar — the name varies by state. You can find your state's office through the Centers for Medicare & Medicaid Services website or by calling 211, which is a free referral line that connects you to local health and human services.

You will need to provide proof of age, income, assets, and citizenship or immigration status. Proof of income might be recent pay stubs, tax returns, or a letter from Social Security. Proof of assets might be bank statements. The exact documents your state requires will be listed when you contact them.

Processing time varies by state, but most decisions come within 30 to 45 days. Some states offer faster processing if you are applying because you need nursing home care or other urgent services.

Medicaid and nursing home costs

Nursing home care is expensive — the national average is over $100 per day, though costs vary widely by region and facility type. Medicare covers only the first 100 days under specific conditions. After that, most people either pay privately or rely on Medicaid.

Medicaid will pay for a nursing home stay if you meet your state's income and asset limits. However, Medicaid has spend-down rules. If you have too many assets, you must spend them down to the state limit before Medicaid begins paying. Some assets are protected — your home, one vehicle, and personal items, for example — but savings and investments are not.

This is why some elderly people or their families work with an elder law attorney to plan ahead. There are legal ways to protect some assets while still becoming Medicaid-may be able to access, but the rules are complex and state-specific. If you think you may need nursing home care in the future, it is worth understanding your state's rules before a crisis forces a decision.

The difference between Medicare and Medicaid for elderly people

Medicare is a federal insurance program you become may be able to access for at 65, regardless of income. You pay premiums (unless you have worked long enough to may have access to for premium-free Part A), and it covers hospital care, doctor visits, and some other services. It does not cover nursing home care, in-home personal care, or dental and vision care.

Medicaid is a needs-based program. You must have low income and few assets to may have access to. It covers services Medicare does not, especially long-term care. If you have both, Medicaid fills in gaps that Medicare leaves.

Some elderly people have neither program — they are over 65 but have not signed up for Medicare, or they have too much income or assets for Medicaid. These people must pay for health care out of pocket or through a private insurance plan.

Medicaid planning and protecting your assets

If you are approaching 65 or already elderly and worried about long-term care costs, you may want to understand Medicaid's rules before you need care. Some strategies — such as transferring assets to family members or setting up certain trusts — can help you become Medicaid-may be able to access while protecting some wealth. However, Medicaid has a look-back period, usually five years, during which it examines transfers you made. Transfers made during this period may delay your Medicaid coverage.

These rules are complicated and state-specific. An elder law attorney in your state can explain what is legal and what makes sense for your situation. Many offer free or low-cost initial consultations. This is different from general legal advice — it is planning specific to your state's Medicaid rules and your family's circumstances.

Frequently Asked Questions

Do I have to be on Medicare to get Medicaid at 65?

No. You can have Medicaid without Medicare, though most people over 65 have Medicare. If you have not worked long enough to may have access to for Medicare, or if you have not signed up, you can still be covered by Medicaid if your income and assets are low enough for your state.

Will Medicaid pay for my assisted living facility?

Some states cover assisted living through Medicaid; others do not. Coverage and payment levels vary widely. You must check your state's Medicaid program. If your state does not cover it, you may pay out of pocket or look for facilities that accept Medicaid for specific services like nursing care.

What happens to my home if I go on Medicaid?

Your home is usually protected. Medicaid does not force you to sell your home to become may be able to access. However, after you die, some states can recover money Medicaid spent on your care by placing a lien on your estate. Your state's rules on estate recovery vary, so ask your Medicaid office about this.

Can my adult child's income count against me for Medicaid?

No. Medicaid looks at your income and assets only, not your family members'. Your child's income does not affect whether you may have access to, even if you live with them or they support you.

How do I know if I should apply for Medicaid or just stay on Medicare?

If your income is low and you have high medical costs — especially if you need nursing home care, in-home care, or have large Medicare copayments — Medicaid may help. Call your state's Medicaid office or 211 to learn your state's income limits. They can tell you whether you may be covered and what to do next.