Medicaid covers people 65 and older, but the rules are different than for younger adults

No, Medicaid is not only for people under 64. Medicaid covers adults age 65 and older, though the way it works changes at that age. Once you turn 65, you become may be able to access for Medicare — the federal program for seniors — and Medicaid becomes a secondary payer in most cases. This means Medicare covers your primary medical costs, and Medicaid can help pay what Medicare does not cover, like copayments, deductibles, and long-term care.

The income and asset limits for Medicaid do not change at 65, but your coverage path does. If you were already on Medicaid before 65, your coverage usually continues without interruption. If you are turning 65 and not yet on Medicaid, you can still apply. The timing matters because Medicare enrollment has deadlines, and missing them can cost you in penalties.

Key Takeaways

  • Medicaid covers people 65 and older in all states, but it works alongside Medicare rather than replacing it.
  • Once you turn 65, you must enroll in Medicare Part A and Part B during your enrollment window, or face lifetime penalties on Part B premiums.
  • If you are 65 or older and have low income, you can apply for Medicaid in your state to help cover Medicare costs you cannot afford.
  • Some people 65 and older may have access to for both Medicare and Medicaid — called "dual may be able to access" — and receive coverage from both programs.

How Medicaid and Medicare work together for people 65 and older

When you turn 65, Medicare becomes your primary insurance. Medicaid then acts as a secondary payer, meaning it covers costs that Medicare does not pay. This includes Medicare Part B premiums (currently $164.90 per month for most people in 2024, though this amount changes yearly), Part D prescription drug deductibles, and copayments for doctor visits and hospital stays.

You do not lose Medicaid coverage when you turn 65 if you were already enrolled. Your state Medicaid program will coordinate with Medicare automatically. If you were not on Medicaid before 65, you can still apply at any time. There is no age cutoff for Medicaid applications — your state will review your income and assets to determine whether you meet the limits.

The income limits for Medicaid vary by state. Some states use the federal poverty level as a benchmark; others set their own limits higher or lower. For 2024, the federal poverty level for a single person is $14,580 per year. Many states allow seniors to have slightly higher income than younger adults because of medical expenses, but you will need to check your state's specific rules.

What happens to your Medicaid when you turn 65

If you are already on Medicaid and turn 65, your coverage does not stop. Your state will update your case to reflect that you are now may be able to access for Medicare. You will be asked to enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) during your Initial Enrollment Period, which runs from three months before your 65th birthday through three months after.

If you miss this window, you can still enroll in Medicare later, but you will owe a lifetime penalty on Part B premiums — an extra 10 percent added to your monthly bill for each year you were may be able to access but did not enroll. This penalty never goes away. Medicaid will not cover this penalty, so it is important to enroll on time even if you think you cannot afford the premium, because Medicaid can help pay it once you are enrolled.

Your state Medicaid program will send you a notice when you turn 65 explaining what happens next. If you do not receive one, contact your state Medicaid office directly. Do not assume your coverage continues without action — some states require you to confirm your information or complete a renewal form.

Income and asset limits for seniors on Medicaid

Medicaid income limits for people 65 and older are the same as for younger adults in most states. However, some states have created medically needy pathways that allow seniors with higher income to may have access to if their medical expenses are high enough. For example, if your monthly income is above the limit but you have significant Medicare premiums, copayments, and prescription drug costs, those expenses can be subtracted from your income to bring you below the threshold.

Asset limits also apply to seniors. Most states allow a single person to have up to $2,000 in countable assets and a married couple up to $3,000, though some states have higher limits. Not all assets count — your home, one vehicle, and certain retirement accounts are usually excluded. If you are considering applying for Medicaid as a senior, gather your bank statements, investment account statements, and property records before you start.

Long-term care changes the rules significantly. If you need nursing home or assisted living care, Medicaid can pay for it, but the asset limits are much stricter. Some states allow only $2,000 for a single person in a facility. You may hear about spend-down strategies or asset protection planning — these are legal ways to structure your finances so you can may have access to for Medicaid coverage of long-term care. An elder law attorney in your state can explain your options.

Applying for Medicaid at 65 or older

You can apply for Medicaid at any age, including after you turn 65. The application process is the same as for younger adults: you submit your income, asset, and household information to your state Medicaid office. You can apply online through your state's website, by mail, by phone, or in person at your local office. Processing usually takes 30 to 45 days, though some states are faster.

You will need to provide proof of income (recent pay stubs, Social Security statements, or pension letters), proof of citizenship or immigration status, and proof of residency. If you are already receiving Social Security, your state can verify your income directly with the Social Security Administration, which speeds up the process. Bring your Social Security number and any documentation of your current health insurance.

If you are turning 65 soon and think you might may have access to for Medicaid, apply before your birthday. This way, if you are approved, your coverage can start on the first day of the month you turn 65, and Medicaid can help pay your Medicare premiums from the start. If you apply after 65, coverage typically begins the first day of the month after approval.

Special Medicaid programs for seniors

Some states offer Medicaid Savings Programs specifically for people 65 and older with low income. These programs pay your Medicare Part B premium, and sometimes Part D deductibles and copayments, even if your income is slightly above the regular Medicaid limit. The income threshold for these programs is usually higher than standard Medicaid — often around 135 to 200 percent of the federal poverty level depending on your state.

Another option is Medicare Savings Programs (MSP), which are jointly funded by Medicare and Medicaid. MSP covers your Part B premium and sometimes Part A premiums as well. You apply through your state Medicaid office, and the income limits are more generous than full Medicaid. If you are 65 or older and struggling to pay Medicare premiums, ask your state Medicaid office whether you may have access to for MSP.

If you need long-term care — nursing home, assisted living, or home care — Medicaid is often the only program that will pay for it. Medicare covers only short-term skilled nursing care after a hospital stay. Many seniors plan ahead by learning about Medicaid's long-term care coverage rules while they are still healthy, so they understand their options if care becomes necessary.

Frequently Asked Questions

Do I have to enroll in Medicare when I turn 65 if I am on Medicaid?

Yes. Even if Medicaid is paying your medical bills, you must enroll in Medicare Part A and Part B during your Initial Enrollment Period (three months before through three months after your 65th birthday). If you do not, you will owe a lifetime penalty on Part B premiums. Medicaid cannot cover this penalty.

What if my income is too high for Medicaid but I cannot afford Medicare premiums?

You may may have access to for a Medicare Savings Program or a Medicaid Savings Program, which have higher income limits than full Medicaid. These programs specifically help pay Medicare premiums and copayments. Contact your state Medicaid office to learn the income thresholds in your state.

Can Medicaid pay for nursing home care if I am 65 or older?

Yes. Medicaid is the largest payer of long-term care in the United States. If you need a nursing home and meet your state's income and asset limits, Medicaid can cover the cost. Asset limits for long-term care are stricter than for regular Medicaid, so speak with an elder law attorney or your state Medicaid office about planning ahead.

If I was denied Medicaid before 65, can I reapply after I turn 65?

Yes. Your circumstances may have changed — your income may have decreased, or you may now may have access to for a seniors-only program. Reapply through your state Medicaid office. Bring updated income documentation and ask specifically about Medicare Savings Programs, which have different rules than regular Medicaid.

Does Medicaid cover dental or vision care for seniors?

Coverage varies by state. Some states include dental and vision benefits for seniors on Medicaid; others do not. Contact your state Medicaid office to learn what is covered where you live. Medicare does not cover routine dental or vision care, so if your state does not offer it through Medicaid, you may need to pay out of pocket or purchase a separate plan.