Medicare and Medicaid are different programs with different rules

Medicare and Medicaid sound similar but work in completely different ways. Medicare is a federal health insurance program for people 65 and older, regardless of income — and for some younger people with disabilities or end-stage renal disease. Medicaid is a joint federal and state program that covers low-income individuals and families of any age. You may be able to get one, both, or neither, depending on your age and income.

The key difference: Medicare is based on age or disability status. Medicaid is based on income and household size. A 68-year-old with a high income gets Medicare automatically but may not get Medicaid. A 35-year-old with low income may get Medicaid but not Medicare. Some people may have access to for both — this combination is sometimes called "dual may be able to access."

Understanding which program you might be able to access depends on answering a few straightforward questions about your age, income, and where you live. The steps to get each one are different, and the paperwork required is different.

Key Takeaways

  • Medicare is for people 65 and older or those with certain disabilities, and you must sign up through Social Security; it is not based on income.
  • Medicaid is for low-income individuals and families, and you explore through your state's Medicaid office, not the federal government.
  • You can have both Medicare and Medicaid at the same time if you meet the age or disability requirement for Medicare and the income requirement for Medicaid.
  • Medicare enrollment windows are strict — missing the important date can cost you penalties and delayed coverage, so timing matters.
  • Medicaid rules vary significantly by state, including income limits and what services are covered, so your state's program may differ from a neighboring state's.

How to get Medicare if you are 65 or older

If you are turning 65, you become may be able to access for Medicare automatically on the first day of the month you turn 65 (or the month after, depending on your birth date). You do not have to wait for a letter or an invitation. However, you must take action to enroll — Medicare does not sign you up without your request.

You enroll through Social Security, not through Medicare directly. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. The process takes about 10 minutes online. You will need your Social Security number and basic information about your income and citizenship status.

Your coverage begins the first day of the month you turn 65, as long as you enroll during your Initial Enrollment Period. This period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you miss this window, you can still enroll, but you may face a permanent penalty on your premiums — typically 10 percent per year of delay. The only exception is if you or your spouse are still working and covered by an employer health plan; in that case, you have an eight-month grace period after leaving that job to enroll without penalty.

How to get Medicare if you have a disability or end-stage renal disease

You can get Medicare before 65 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). If you receive SSDI, Medicare begins automatically after your 24-month waiting period — you do not need to do anything.

If you have ESRD or ALS, you must enroll through Social Security. Contact Social Security at 1-800-772-1213 or visit ssa.gov to start the process. You will need medical documentation of your diagnosis. Coverage can begin as early as the first month of your diagnosis (for ALS) or the month you start dialysis or receive a transplant (for ESRD).

How to get Medicaid based on income

Medicaid is run by each state, so the process and income limits differ depending on where you live. There is no single national Medicaid office to contact. Instead, you explore through your state's Medicaid agency, which may be called the Department of Social Services, Department of Health and Human Services, or Department of Medical information — the name varies by state.

To find your state's Medicaid office, visit medicaid.gov and select your state from the map, or call 1-800-MEDICARE and ask for a referral to your state Medicaid program. You can also search online for "[Your State] Medicaid" or "[Your State] MAGI Medicaid" (MAGI stands for Modified Adjusted Gross Income, the income measure most states use).

Income limits for Medicaid vary by state and household size. Some states cover individuals earning up to 138 percent of the federal poverty line; others have lower or higher limits. For 2024, the federal poverty line for a single person is approximately $14,600 per year, but your state may set its own threshold. When you contact your state Medicaid office, they can tell you when ready whether your income falls within the range.

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 proof of residency in your state. Some states allow you to explore online, by mail, or in person; others require a phone interview. Processing typically takes 30 to 45 days, though some states are faster.

Understanding the Medicare enrollment periods and important date

Medicare has strict enrollment windows, and missing them can be costly. The Initial Enrollment Period is seven months centered on your 65th birthday month. If you miss it, you enter the General Enrollment Period, which runs January 1 through March 31 each year. However, if you enroll during General Enrollment, your coverage does not start until July 1, and you will pay a 10 percent penalty on Part B premiums for life.

If you are still working at 65 and covered by your employer's health plan, you can delay Medicare without penalty. You have an eight-month window after you leave that job to enroll. You will need a letter from your employer confirming your coverage dates.

Once you are enrolled in Medicare, you can make changes during the Annual Enrollment Period, which runs October 15 through December 7 each year. Changes take effect January 1. Outside these windows, you can only change plans if you have a may have access to life event — such as losing employer coverage, moving out of state, or becoming may be able to access for Medicaid.

What happens if you may have access to for both Medicare and Medicaid

If you are 65 or older (or disabled and on Medicare) and your income is low enough to may have access to for Medicaid, you are considered dual may be able to access. Medicaid becomes your secondary payer, covering costs that Medicare does not — such as copayments, coinsurance, and deductibles. In some states, Medicaid also covers services Medicare does not, such as long-term care or dental work.

You do not need to do anything special to coordinate the two programs. Once you are enrolled in both, the billing happens automatically. However, you should tell your healthcare providers that you have both, because they need to bill Medicare first and then Medicaid for the remainder.

If you are dual may be able to access, you may also be able to join a Medicare Savings Program, which helps pay your Medicare premiums and cost-sharing. These programs are run by your state and have their own income limits (usually slightly higher than Medicaid). Ask your state Medicaid office whether you may have access to.

Common mistakes to avoid when enrolling

The most common mistake is missing the Initial Enrollment Period for Medicare. Many people assume they will be automatically enrolled at 65 or that they can enroll anytime. This is not true. If you turn 65 this month, you have until three months after your birthday to enroll without penalty. Mark your calendar now.

Another mistake is not reporting changes in income or household size to Medicaid. If your income increases, you may lose Medicaid coverage. If it decreases, you may become may be able to access. Your state Medicaid office should have a process for reporting changes — usually online or by phone. Do not assume your coverage will adjust automatically.

A third mistake is not checking whether you may have access to for both programs. Many people who are 65 and low-income do not realize they can get Medicaid in addition to Medicare. The combination can significantly reduce your out-of-pocket costs. Contact your state Medicaid office to ask whether you may have access to.

Frequently Asked Questions

Can I get Medicare before I turn 65?

Yes, if you have been receiving Social Security Disability Insurance for 24 months, or if you have end-stage renal disease or ALS. Otherwise, you must wait until 65. If you have a disability and are not yet on SSDI, contact Social Security to learn about that program first.

What if I miss the Medicare enrollment important date?

You can still enroll during the General Enrollment Period (January 1 through March 31), but your coverage will not start until July 1, and you will pay a permanent 10 percent penalty on Part B premiums. The only way to avoid this penalty is if you were covered by an employer health plan when you turned 65 — in that case, you have eight months after leaving that job to enroll without penalty.

Do I have to enroll in all parts of Medicare?

Part A (hospital insurance) is automatic for most people 65 and older and has no premium. Part B (medical insurance) requires enrollment and has a monthly premium. Part D (prescription drug coverage) is optional but recommended; if you do not enroll when first may be able to access, you may face a penalty later. You can decline Part B or Part D, but understand the consequences before you do.

How do I know if my state has expanded Medicaid?

Some states have expanded Medicaid to cover more low-income adults; others have not. Your state's Medicaid office can tell you the income limit in your state. You can also visit medicaid.gov and select your state to see the current rules. If your state has not expanded Medicaid, the income limit may be much lower than in neighboring states.

Can I explore for Medicaid online?

Many states allow online applications through their Medicaid website, but not all. Some require a phone interview or in-person visit. Contact your state Medicaid office to find out which methods are available in your state. Online applications are often faster than mail or phone.