Medicare and Medicaid serve different groups, even though their names sound alike

Medicare is a federal program for people 65 and older, regardless of income. You also become may be able to access at any age if you receive 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 for people with low income — the income limit and exact rules depend on which state you live in.

The two programs overlap for some people. You can have both Medicare and Medicaid at the same time if you meet the age or disability requirement for Medicare and your income falls below your state's Medicaid limit. People with both are sometimes called "dual may be able to access."

Key Takeaways

  • Medicare covers people 65 and older, people under 65 who receive SSDI for 24 months, and people with end-stage renal disease or ALS, regardless of income.
  • Medicaid covers people with low income, and the income threshold varies by state and by family size.
  • You can have both Medicare and Medicaid if you meet Medicare's age or disability requirement and your income is low enough for your state's Medicaid program.
  • Each state sets its own Medicaid income limits, so you must check your specific state's rules to know whether you would be covered.

Medicare may be able to access: age, disability, or specific medical conditions

You become may be able to access for Medicare at age 65 if you or your spouse paid Medicare taxes while working. You do not have to be retired. If you were not a U.S. citizen for at least five years, you may have a longer waiting period, but you can still enroll.

If you are under 65, you become may be able to access for Medicare after you have received SSDI for 24 consecutive months. This means you must have been approved for disability and waited two years before Medicare coverage begins. If you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis), you can enroll in Medicare regardless of age, though the timing rules differ slightly for each condition.

You must actively enroll in Medicare during your enrollment window. If you turn 65 and do not sign up when you are supposed to, you may face a permanent penalty on your premiums. The initial enrollment period runs three months before, the month of, and three months after your 65th birthday.

Medicaid may be able to access: income limits that vary by state

Medicaid covers people with low income, but "low income" means different things in different states. Your state's Medicaid program sets its own income threshold based on the federal poverty level. Some states cover people up to 138% of the federal poverty level; others cover only up to 100% or less.

For 2024, the federal poverty level for a single person is approximately $14,600 per year, and for a family of four it is approximately $30,000 per year. If your state covers up to 138% of poverty, a single person could earn roughly $20,100 and still be covered. But if your state covers only 100% of poverty, the limit would be around $14,600. Your state's website or your local Medicaid office can tell you the exact threshold for your household size.

Medicaid also considers assets in some cases, though the rules vary. Some states have asset limits; others do not. You should contact your state Medicaid program directly to learn whether your savings, car, or home would affect your coverage.

How to find out your state's Medicaid income limit

Each state runs its own Medicaid program under federal guidelines, so the income limit for your household depends on where you live. You can find your state's specific limit by visiting your state health department website or calling your local Medicaid office. Many states also have online tools that let you enter your income and household size to see whether you might be covered.

If you do not know your state Medicaid office number, you can call 211 (a free helpline) and ask for your local Medicaid program, or search "[your state] Medicaid" online. Having your household income and the number of people in your household ready will speed up the conversation.

People who can have both Medicare and Medicaid

If you are 65 or older and your income is low enough for your state's Medicaid program, you can have both. The same is true if you are under 65, receiving SSDI, and your income falls below your state's limit. Medicaid then pays for costs that Medicare does not cover, such as copayments, coinsurance, and some services Medicare does not include.

People with both programs are sometimes called "dual may be able to access" or "Medicare-Medicaid enrollees." Your state Medicaid program coordinates with Medicare to avoid duplicate coverage and to make sure you get the full benefit of both programs.

Special situations: pregnancy, disability, and family coverage

Medicaid covers pregnant people and children in every state, with higher income limits than for adults. The exact income threshold for pregnant people and children varies by state, but it is always higher than the limit for non-pregnant adults. If you are pregnant and your income is above your state's regular Medicaid limit but below the pregnancy limit, you can still be covered during pregnancy and for a period after birth.

Parents and caretakers of children may also be covered under Medicaid in some states, though the income limit is usually lower than for children themselves. Some states also cover people with disabilities who do not yet may have access to for SSDI, using different income and asset rules. Your state Medicaid office can tell you whether you fall into any of these categories.

What happens after you determine you might be covered

If you think you meet the requirements for Medicare, you can enroll through Medicare.gov, by phone at 1-800-MEDICARE, or at your local Social Security office. If you think you meet the requirements for Medicaid, contact your state Medicaid program directly — there is no single national application.

You will need to provide proof of income (such as recent pay stubs or tax returns), proof of citizenship or legal residency, and proof of your Social Security number. The exact documents your state requires may vary, so ask when you contact them. Processing times also vary by state, but most programs make a decision within 30 to 45 days.

Frequently Asked Questions

Can I have Medicare if I am still working?

Yes. Medicare may be able to access at 65 does not depend on retirement. If you are still working and earning income, you can still enroll in Medicare. However, if you are under 65 and receiving SSDI, your earnings are limited — if you earn too much, you may lose your SSDI and therefore your Medicare may be able to access.

Does my spouse's income count toward my Medicaid limit?

It depends on your state and your situation. For most Medicaid programs, only your own income counts. However, if you are married and applying together, some states count both incomes. Contact your state Medicaid office to learn the rule for your household.

What if my income is just above my state's Medicaid limit?

Some states have programs for people slightly above the Medicaid income limit. These are sometimes called "spend-down" programs or medically needy programs. You may also be covered if you have high medical expenses that reduce your countable income. Ask your state Medicaid office whether you have other options.

Can I lose Medicare or Medicaid coverage?

Medicare coverage at 65 is permanent as long as you pay your premiums. Medicaid coverage can end if your income rises above your state's limit, if you move to another state, or if you no longer meet other requirements. Your state will notify you if your coverage is ending and give you a chance to appeal.

How do I know if I am receiving SSDI or SSI?

SSDI (Social Security Disability Insurance) is based on your work history; SSI (Supplemental Security Income) is based on low income and assets. You can check your Social Security statement online at ssa.gov or call 1-800-772-1213. The distinction matters because SSDI leads to Medicare after 24 months, while SSI does not.