Medicare and Medicaid are two separate programs with different rules

Medicare and Medicaid sound similar but work completely differently. 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, regardless of income. Medicaid is a joint federal and state program that pays for health care based on income and family size — and the rules change depending on which state you live in.

The confusion happens because both programs exist, both use the same federal agency to administer parts of their operations, and both can cover the same person at the same time. But the path to getting each one is different, what they cover is different, and how much you pay is different.

Key Takeaways

  • Medicare is based on age (65 and older) or disability status, while Medicaid is based on income and family size.
  • You can have both Medicare and Medicaid at the same time — this is called being "dual may be able to access."
  • Medicaid rules vary significantly by state, so what you may have access to for in one state may not apply in another.
  • Medicare has four parts (A, B, C, D) that cover different services, and you choose which parts to enroll in.
  • Medicaid covers more services than Medicare in most states, including dental, vision, and long-term care.

Who gets Medicare based on age and work history

You become may be able to access for Medicare at age 65 if you or your spouse paid into the Social Security system for at least 10 years (40 quarters of work). You do not have to be retired — you can still be working. You do not have to be poor. Income does not matter at all for Medicare may be able to access based on age.

If you are under 65, you can still get Medicare if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These are the only disability pathways into Medicare before age 65.

You enroll in Medicare during your Initial Enrollment Period, which is the three months before the month you turn 65, the month itself, and the three months after. If you miss this window and do not have other may have access to coverage, you pay a permanent penalty on your Part B premium for as long as you have Medicare.

Who gets Medicaid based on income and state rules

Medicaid is the program that actually has income limits. You may have access to if your household income falls below a threshold set by your state. That threshold varies widely — some states cover people making 138% of the federal poverty level, others cover much less. In 2024, the federal poverty level for a single person is around $14,600 per year, but your state may use a different percentage or calculation.

Medicaid also looks at family size, assets (in some states), and citizenship status. You must be a U.S. citizen or may have access to immigrant. Some states have expanded Medicaid to cover more people; others have not. If you live in a state that did not expand Medicaid, you may earn too much for Medicaid but too little for a marketplace insurance subsidy — this gap is sometimes called the "coverage gap."

Medicaid is not automatic at any age. You have to apply through your state's Medicaid office or through the healthcare marketplace (Healthcare.gov or your state's equivalent). The application asks about income, family size, citizenship, and sometimes assets. Processing times vary by state but typically take 30 to 45 days.

When you have both Medicare and Medicaid at the same time

You can be enrolled in both programs simultaneously. This happens most often when someone turns 65, qualifies for Medicare, but still has low enough income to also may have access to for Medicaid. People in this situation are called dual may be able to access.

When you are dual may be able to access, Medicare is your primary insurance and Medicaid is secondary. Medicare pays first, then Medicaid can cover costs Medicare does not pay — like copayments, coinsurance, and some services Medicare does not cover at all. This can significantly reduce your out-of-pocket costs.

Some states offer special Medicaid programs for dual-may be able to access people, such as Medicaid Savings Programs (also called Medicare Savings Programs or MSPs). These programs pay your Medicare premiums and sometimes your deductibles and copayments. You have to apply separately for these programs, and rules vary by state.

What Medicare covers versus what Medicaid covers

Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient care, and preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers.

Medicaid covers more services in most states. It typically covers doctor visits, hospital care, prescription drugs, and preventive services like Medicare does. But Medicaid also often covers dental care, vision care, hearing aids, and long-term care (nursing home or in-home services) — services Medicare does not cover or covers only minimally. Medicaid also covers family planning and pregnancy-related services.

The exact services covered depend on your state's Medicaid program. Some states cover more; some cover less. If you have both Medicare and Medicaid, Medicaid can fill in gaps that Medicare leaves.

Special situations: disability, pregnancy, and children

You can get Medicaid at any age if you receive SSDI or Supplemental Security Income (SSI). SSI is a needs-based program for people who are blind, disabled, or 65 and older with very low income and few assets. If you receive SSI, you automatically may have access to for Medicaid in most states (though a few states have different rules).

Pregnant people and children have their own Medicaid pathways in every state. Income limits for pregnant people and children are typically higher than for adults. Some states cover pregnant people up to 200% of the federal poverty level. Children may be covered up to 300% of poverty in some states. These higher limits exist because federal law requires states to cover pregnant people and children more broadly than other adults.

If you are pregnant and uninsured, apply for Medicaid immediately — coverage is retroactive in most states, meaning it can cover services from the month you applied, not just from the month you were approved.

How to find out what you may have access to for in your state

The fastest way to learn what you might may have access to for is to contact your state's Medicaid office directly. You can find it by searching "[your state] Medicaid" or by calling 211 (a free helpline that connects you to local resources). You can also visit Healthcare.gov, which has a tool that shows you programs available in your state based on your income and family size.

If you are 65 or older, you automatically may have access to for Medicare at 65 — there is nothing to check. You just need to enroll during your Initial Enrollment Period. If you are under 65, you can check whether you may have access to for Medicaid by contacting your state office or using the Healthcare.gov tool.

Keep in mind that Medicaid rules change. Some states expand or contract their programs. Income limits shift. If you were told you did not may have access to a year ago, it is worth checking again — your situation or your state's rules may have changed.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. This is called being dual may be able to access. Medicare is your primary insurance and pays first. Medicaid then covers some of the costs Medicare does not pay, like copayments and deductibles. Many people over 65 with low income have both programs.

Do I have to be retired to get Medicare?

No. You become may be able to access for Medicare at 65 based on age and work history, whether you are still working or not. You can keep working and have Medicare at the same time. You do not have to retire.

What if I live in a state that did not expand Medicaid?

In non-expansion states, Medicaid income limits are lower, and some adults with low income do not may have access to for either Medicaid or marketplace subsidies. You may still may have access to for marketplace insurance through Healthcare.gov, or you may want to explore whether you may have access to for other programs like CHIP (for children) or state-specific programs.

How long does it take to get approved for Medicaid?

Most states process Medicaid applications within 30 to 45 days. Some states are faster. If you are pregnant or applying for a child, some states prioritize those applications. You can contact your state Medicaid office to ask about processing times in your area.

If I turn 65, do I automatically get Medicaid?

No. You automatically become may be able to access for Medicare at 65, but Medicaid is separate and based on income. You have to apply for Medicaid separately. If your income is low enough, you may may have access to for both, but you have to apply for Medicaid to enroll.