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 become covered at age 65 if you or your spouse paid Medicare taxes while working, or earlier if you have end-stage renal disease, ALS, or have received Social Security Disability Insurance (SSDI) for 24 months. You pay premiums, deductibles, and copays.

Medicaid is a joint federal and state program that covers people with low income. Each state sets its own income limits and decides which groups it covers. You do not need a work history to get Medicaid. In some states, Medicaid covers people earning up to 138% of the federal poverty line; in others, the limit is much lower.

Some people have both programs at the same time — this is called "dual coverage." Medicare is your primary insurance, and Medicaid fills in gaps like copays and deductibles. The two programs do not compete; they work together.

Key Takeaways

  • Medicare is based on age (65+) or disability; Medicaid is based on income and varies by state.
  • You must sign up for Medicare during your Initial Enrollment Period (the three months before, during, and after your 65th birthday) or face a permanent penalty on your premiums.
  • Medicaid income limits and covered services differ by state, so you need to check your state's rules directly.
  • If you have both Medicare and Medicaid, Medicaid typically pays your Medicare premiums and cost-sharing, which can save you hundreds of dollars per month.
  • You can start the process for both programs through Medicare.gov, your state Medicaid office, or by calling 1-800-MEDICARE.

How to sign up for Medicare at 65

Your Initial Enrollment Period runs for three months: the month you turn 65, the month before, and the month after. If you sign up during this window, your coverage starts on the first day of your birth month (or the first of the following month if you sign up after your birth month).

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. You will need your Social Security number, birth date, and citizenship or legal residency information.

If you miss your Initial Enrollment Period, you can still sign up during the General Enrollment Period (January 1 to March 31 each year), but your coverage will not start until July 1, and you will pay a permanent 10% penalty on your Part B premium for each year you were late. This penalty stays with you for life.

Understanding Medicare Parts A, B, C, and D

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. Part A has a deductible (the amount you pay before Medicare starts paying) that changes each year.

Part B covers doctor visits, outpatient care, lab tests, and medical equipment. You pay a monthly premium, which is usually deducted from your Social Security check. Part B also has a deductible and copays. Your premium amount depends on your income from two years ago.

Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B). Private insurance companies offer Part C plans that bundle hospital, doctor, and usually prescription drug coverage. Part C plans often have lower copays but may limit which doctors and hospitals you can use. You must have Part A and Part B to enroll in Part C.

Part D covers prescription drugs. You can add it to Original Medicare, or it may be included in your Part C plan. Part D has a monthly premium, an annual deductible, and copays that vary by drug. If you do not sign up for Part D when you first become covered by Medicare, you will pay a permanent penalty if you enroll later.

How to learn about you may have access to for Medicaid

Medicaid income limits are set by each state and change yearly. To find your state's current limit, visit your state Medicaid office website or call your state's Medicaid hotline. You can also use the Medicaid.gov website to find your state's contact information.

In addition to income, your state may look at assets (savings, property, investments), family size, age, disability status, and whether you are pregnant or a parent. Some states use "categorical" rules — for example, if you receive SSDI, you automatically meet the income test. Other states use "medically needy" rules, which let you count medical bills as deductions from your income.

The easiest way to start is to contact your state Medicaid office directly. Many states also let you explore online through their Medicaid portal. Have your Social Security number, birth date, income information (pay stubs or tax returns), and proof of citizenship or legal residency ready.

What happens if you have both Medicare and Medicaid

If you have both programs, you are called a dual-may be able to access beneficiary. Medicare is your primary insurance and pays first. Medicaid is your secondary insurance and typically covers your Medicare premiums, deductibles, and copays — this can save you hundreds of dollars each month.

Some states offer special programs for dual-may be able to access people. These programs may coordinate your care, limit which doctors you can see, or offer extra services like dental or vision coverage. Ask your state Medicaid office whether you are enrolled in a special program and what it covers.

If you are dual-may be able to access, you do not need to choose between Medicare Advantage (Part C) and Original Medicare. However, if you are in a state-run dual program, you may have limited choices. Check with your state Medicaid office before changing your Medicare plan.

Timing: when to sign up and what to expect

For Medicare, your Initial Enrollment Period is tied to your 65th birthday. If you are already on Social Security, Medicare will contact you automatically about three months before you turn 65. If you are not on Social Security yet, you must sign up yourself.

For Medicaid, there is no enrollment period — you can explore any time. Processing times vary by state, but most decisions come within 30 to 45 days. Some states process applications faster if you explore online.

If you are turning 65 and think you might may have access to for Medicaid, explore for both programs at the same time. You can explore for Medicare at Medicare.gov and for Medicaid through your state office. Starting both applications early gives you time to resolve any questions before your coverage needs to begin.

Common reasons people have trouble getting coverage

The most common mistake is missing your Medicare Initial Enrollment Period. If you delay signing up for Part B or Part D without a valid reason (such as employer coverage), you will owe a permanent penalty. The penalty is 10% of the Part B premium for each year you were late, and 1% of the average Part D premium for each month you were late. These penalties never go away.

For Medicaid, the most common issue is not understanding your state's specific rules. Income limits, asset limits, and covered services are different in every state. A program that covers dental work in one state may not cover it in another. Always check your state's rules before assuming you know what Medicaid will pay for.

Another common problem is not reporting changes in income or family size to Medicaid. If your income goes up or down, or if someone moves in or out of your household, you must report it. Failing to report changes can result in overpayments that you may have to repay.

Frequently Asked Questions

Can I get Medicare before age 65?

Yes, if you have been receiving SSDI for 24 months, have end-stage renal disease, or have ALS (amyotrophic lateral sclerosis). You can also get Medicare at any age if you have been on dialysis for three months or have had a kidney transplant. Contact Social Security or call 1-800-MEDICARE to learn about you may have access to.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare (Parts A and B) is run by the federal government and lets you see any doctor or hospital that accepts Medicare. Medicare Advantage (Part C) is run by private insurance companies and usually has lower copays but may require you to use doctors and hospitals in their network. Both cover the same basic services, but the costs and rules are different.

Do I have to pay for Medicare?

Most people pay a monthly premium for Part B (usually around $165 to $560 depending on income), and many pay for Part D (prescription drugs). Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years. If you have Medicaid, it may pay your Medicare premiums for you.

What if my state did not expand Medicaid?

Some states have not expanded Medicaid to cover people earning up to 138% of the federal poverty line. In those states, Medicaid may only cover children, pregnant people, parents, elderly people, or people with disabilities — and income limits may be much lower. Check your state's Medicaid website to see what groups your state covers and what the income limits are.

Can I switch from Medicare Advantage back to Original Medicare?

Yes, during the Annual Enrollment Period (October 15 to December 7 each year) or if you have a may have access to life event (such as moving out of your plan's service area). If you switch back to Original Medicare, you may need to sign up for Part D separately. You have 63 days after leaving Medicare Advantage to enroll in a Medigap plan without a waiting period.