The Basic Difference: Age and Income Shape Which Program Covers You

Medicare is primarily for people 65 and older, regardless of income. Medicaid is for people of any age whose income and assets fall below state limits. Some people may have access to for both — this is called "dual may be able to access" status. The path to each program is different, and understanding which one applies to you depends on your age, income, and sometimes your disability status.

You do not choose between them based on preference. Your age and financial situation determine which programs you may be able to use. If you are 65 or older, you will almost certainly be looking at Medicare. If you are younger and have limited income, Medicaid may be your route. If both explore to you, you will work with both programs at the same time.

Key Takeaways

  • Medicare is available to nearly all people 65 and older, plus some younger people with disabilities or end-stage renal disease, regardless of income.
  • Medicaid income and asset limits vary by state, and each state runs its own program with different rules about what it covers.
  • You become may be able to access for Medicare automatically at 65 if you have worked and paid Social Security taxes, or you can sign up through Social Security.
  • Medicaid requires you to contact your state's Medicaid office or use your state's online portal, and the process and timeline differ by state.
  • Some people may have access to for both programs; your state's Medicaid office can tell you whether you are dual may be able to access and how the programs work together.

Who Qualifies for Medicare

You are may be able to access for Medicare if you are 65 or older and you (or your spouse) worked and paid Social Security taxes for at least 10 years. You do not need to be retired — you can still be working. If you are under 65, you may still may have access to if you have received Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis).

If you do not have a work history that qualifies you, you may still be able to get Medicare by paying a monthly premium. Social Security will review your specific situation when you contact them. Most people become may be able to access automatically and do not have to do anything except sign up during the right window.

Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part D (prescription drug coverage), and Part C (Medicare Advantage, an alternative to Parts A and B). Part A and Part B are what most people think of as "Medicare." You must sign up for them during your enrollment window, or you may face a permanent penalty on your premiums.

Who Qualifies for Medicaid

Medicaid is for people of any age whose income is below a certain level set by their state. Each state runs its own Medicaid program and sets its own income and asset limits. In some states, the limit is very low; in others, it is higher. A single person in one state might may have access to with an income of $1,500 per month, while the same income in another state would disqualify them. You must check your specific state's rules.

Most states also look at your assets — money in the bank, property you own, and other resources. Some assets do not count, such as your primary home (in most cases) and one vehicle. The rules about what counts vary by state. Medicaid also covers children, pregnant people, and people with disabilities, often with different income limits than working-age adults.

Some states have expanded Medicaid to cover more working-age adults with low income; others have not. Whether your state has expanded Medicaid affects whether you can get coverage. You can find out whether your state has expanded Medicaid and what the income limit is by contacting your state's Medicaid office or visiting your state's Medicaid website.

How to Sign Up for Medicare

You sign up for Medicare through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You should sign up during your enrollment window — the three months before the month you turn 65, the month you turn 65, and the three months after. If you sign up late, you may pay a higher premium for the rest of your life.

If you are already receiving Social Security benefits when you turn 65, you will be enrolled in Medicare Parts A and B automatically. You do not have to do anything. If you are not yet receiving Social Security, you must sign up for Medicare yourself. You will need your Social Security number and information about your work history.

After you sign up, Social Security will send you a Medicare card in the mail. This usually takes about two weeks. You can use your card to see doctors and get care once it arrives. If you need care before your card arrives, you can show a letter from Social Security that confirms your coverage.

How to Sign Up for Medicaid

You sign up for Medicaid through your state's Medicaid office or through your state's health insurance marketplace. Most states now have an online portal where you can submit information about your income and household. Some states still accept paper applications by mail or in person. You can find your state's Medicaid office by searching "[your state] Medicaid" or by calling 211, which is a free helpline that connects you to local resources.

When you explore, you will need to provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, and information about your household. The exact documents required vary by state. Your state's Medicaid office can tell you what to bring or upload.

Processing time varies by state. Some states make a decision within a few days; others take several weeks. Your state's Medicaid office will tell you how long to expect and will contact you if they need more information. Once you are approved, your coverage usually starts on the first day of the month after you are approved, though some states backdate coverage to the date you applied.

What Happens If You may have access to for Both Medicare and Medicaid

If you are 65 or older with low income, or if you are under 65 and disabled with low income, you may may have access to for both programs. When this happens, Medicare is your primary insurance — it pays first. Medicaid is secondary and covers costs that Medicare does not pay, such as copayments, coinsurance, and deductibles. Medicaid may also cover services that Medicare does not, such as long-term care or dental care (depending on your state).

You do not have to choose. You will be enrolled in both, and they will work together. Your Medicare card and your Medicaid card (or number) are separate, but providers will bill both. If you think you might may have access to for both, tell your state's Medicaid office when you explore — they will determine whether you are dual may be able to access and explain how the programs coordinate.

Income and Asset Limits by State

Medicaid income limits vary widely. As of 2024, some states limit Medicaid for working-age adults to around $1,000 per month for a single person; states that have expanded Medicaid allow income up to around $1,500 to $2,000 per month or higher, depending on the state. These numbers change, and they are different for children, pregnant people, elderly people, and people with disabilities.

Asset limits also vary. Some states have no asset limit for certain groups; others limit assets to $2,000 for a single person or $3,000 for a couple. Your home and one car usually do not count. Retirement accounts and life insurance may or may not count, depending on your state.

Because the rules are so different by state, the only way to know whether you may have access to is to contact your state's Medicaid office or use your state's online process. You can also call 211 and ask for help understanding your state's rules.

Frequently Asked Questions

What if I turn 65 but I have not worked 10 years?

You may still get Medicare by paying a monthly premium. Social Security will calculate what you owe based on your work history. Contact Social Security at 1-800-772-1213 to find out whether you may have access to and what your premium would be. Some people with very limited work history do not may have access to for any form of Medicare and must use Medicaid or buy private insurance instead.

Can I get Medicaid if I am working?

Yes. Medicaid is based on income, not employment status. If your job pays low wages and your income is below your state's limit, you may may have access to for Medicaid even while working. Some states have special programs for working people with disabilities. Contact your state's Medicaid office to find out whether your income qualifies.

What if my state has not expanded Medicaid?

In states without Medicaid expansion, working-age adults with low income may not may have access to for Medicaid unless they are disabled, pregnant, or caring for a child. You may be able to get coverage through the health insurance marketplace instead. Visit healthcare.gov to see what plans and subsidies are available in your state based on your income.

Do I have to sign up for Medicare at 65 even if I am still working?

If you are still working and have health insurance through your job, you can delay signing up for Medicare Part B without penalty, but you should still sign up for Part A. Talk to your employer's benefits office and to Social Security to understand the rules for your situation, because the rules depend on the size of your employer and your specific coverage.

How do I know if I am dual may be able to access?

Your state's Medicaid office will tell you when you explore for Medicaid. If you are 65 or older and your income is below your state's Medicaid limit, you are likely dual may be able to access. If you are under 65 and receiving SSDI, you may also be dual may be able to access. Ask your Medicaid caseworker to confirm your status and explain how Medicare and Medicaid will work together for you.