How Medicare and Medicaid Work — and Which One You Might Qualify For

The Basic Difference Between Medicare and Medicaid

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). You pay into it through payroll taxes during your working years, and it becomes available to you at 65, regardless of income. Medicaid is a joint federal and state program that covers people with low incomes — the income limit and what it covers depend on which state you live in.

The confusion is understandable: both are government programs, both have "Medi" in the name, and both can cover hospital and doctor visits. But they work on completely different rules. Medicare asks "How old are you?" Medicaid asks "How much money do you have?" Understanding which one applies to you — or whether you may have access to for both — changes what you pay and what services you can use.

Key Takeaways

Medicare is available at 65 if you or your spouse paid Medicare taxes for at least 10 years; income does not matter.
Medicaid is based on income and assets, and the income limit varies by state — you may may have access to in one state but not another.
You can have both Medicare and Medicaid at the same time; Medicaid can help pay Medicare premiums and cover services Medicare does not.
You must take action to enroll in Medicare at 65 or face late penalties; Medicaid enrollment is ongoing and does not have an age important date.
Your state Medicaid office and Medicare.gov are the official sources to learn what you may have access to for based on your specific situation.

Who Qualifies for Medicare at 65

You may have access to for Medicare at 65 if you or your spouse paid Medicare payroll taxes (the 2.9% deduction from your paychecks) for at least 10 years — that is 40 quarters of work. You do not have to be retired. You do not have to be a U.S. citizen, but you must be a permanent resident who has lived in the U.S. for at least five years.

If you do not have 10 years of Medicare tax history, you may still enroll in Medicare Part B and Part D (prescription drug coverage) by paying a monthly premium, but you will not receive Part A (hospital insurance) for free. Some people who do not may have access to through work history can purchase Part A coverage.

You become may be able to access the first day of the month you turn 65. You do not have to wait until your birthday month to enroll — in fact, you should enroll during the three months before you turn 65 to avoid a late enrollment penalty. If you miss that window, you can still enroll, but your Part B premium will be permanently higher.

Who Qualifies for Medicaid Based on Income and Assets

Medicaid covers people with low incomes and limited assets. The income threshold varies significantly by state. In 2024, some states cover adults earning up to roughly 138% of the federal poverty level (about $1,900 per month for a single person), while others set the limit much lower. A few states have not expanded Medicaid at all, so the income limit for adults without children or disabilities is very restrictive.

Asset limits also vary by state. Most states count cash, savings accounts, and investments toward the limit, though they usually do not count your home or one vehicle. If you are over 65 or have a disability, some states use different asset limits than they do for younger adults.

The only way to know whether you may have access to in your state is to contact your state Medicaid office or use your state's online screening tool. Your income and assets today determine whether you may have access to now, but Medicaid recertifies periodically — usually every 12 months — so your status can change.

Having Both Medicare and Medicaid at the Same Time

You can hold both programs simultaneously. People who have both are called dual may be able to access. This happens most often when someone turns 65 and qualifies for Medicare, but their income is still low enough for Medicaid.

When you have both, Medicare is your primary insurance and pays first. Medicaid then covers costs that Medicare does not — such as copayments, coinsurance, and some services like long-term care. Medicaid can also pay your Medicare Part B and Part D premiums if you cannot afford them. This combination can significantly reduce your out-of-pocket costs.

If you are already on Medicaid when you turn 65, you must still enroll in Medicare Part A and Part B during your enrollment window. Your state Medicaid office should notify you, but do not rely on that — contact Medicare directly at 1-800-MEDICARE to confirm you are enrolled.

Special Rules for People Under 65

You can may have access to for Medicare before 65 if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). In these cases, you become may be able to access regardless of age.

People under 65 with disabilities or end-stage renal disease should contact Social Security or Medicare directly to learn about their specific enrollment timeline. The rules are different from standard age-65 enrollment, and missing important date can result in gaps in coverage.

How to Find Out What You may have access to For

For Medicare: Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). You can also visit your local Social Security office. They will tell you whether you have enough work history to may have access to for Part A for free, and what your Part B and Part D premiums would be.

For Medicaid: Contact your state Medicaid office directly — the phone number and website are on your state's health department website. Many states also have online income and asset screening tools that give you an answer in minutes. You can also call 211 (dial 2-1-1) and ask for a referral to your state Medicaid office.

Bring or have ready: your Social Security number, proof of income (recent pay stubs, tax returns, or a letter from Social Security), proof of citizenship or permanent residency, and a list of your assets if you are explore for Medicaid. Having these documents ready speeds up the process.

What Happens After You may have access to

For Medicare: Once you enroll, your coverage begins on the first day of the month you turn 65 (or the month you become may be able to access if you may have access to early). You will receive a Medicare card in the mail. You then choose how to receive your coverage: Original Medicare (Parts A and B) plus a separate Part D plan, or a Medicare Advantage plan (Part C), which bundles hospital, medical, and prescription drug coverage.

For Medicaid: Once you are approved, your coverage usually begins on the first day of the month you applied, or sometimes retroactively to cover medical bills from the three months before you applied. You will receive a Medicaid card or an explanation of benefits. Your state will tell you which doctors and hospitals accept your Medicaid plan.

Both programs require you to stay in touch with them. If your income, address, or household changes, you must report it. Medicaid recertifies your status periodically, and if you do not respond to a recertification notice, your coverage can end.

Frequently Asked Questions

Can I turn down Medicare at 65 and stay on Medicaid only?

Technically yes, but it is usually not a good idea. If you have Medicaid and turn 65, Medicaid expects Medicare to be your primary insurance. If you refuse Medicare, Medicaid may refuse to cover costs that Medicare would have covered. You should enroll in Medicare Part A at minimum, even if you delay Part B.

What if I worked in another country — does that count toward the 10 years for Medicare?

Generally no. You need 10 years of work history in the U.S. where you paid Medicare taxes. Some countries have agreements with the U.S. that allow work credits to be combined, but this is rare. Contact Social Security to ask about your specific work history.

If I do not may have access to for Medicaid in my state, what are my other options?

You may may have access to for subsidies to help pay for private insurance through the Health Insurance Marketplace (Healthcare.gov). You may also may have access to for cost-sharing reductions that lower your copayments and deductibles. Contact your state's health insurance marketplace or call 1-800-318-2596 to learn what you may may have access to for based on your income.

Can I explore for Medicare and Medicaid at the same time?

You explore to them separately — they are run by different agencies. However, when you explore for Social Security retirement benefits, you can ask to be enrolled in Medicare at the same time. For Medicaid, you must explore through your state Medicaid office or your state's health insurance marketplace.

What if my income goes up after I may have access to for Medicaid?

Medicaid will recertify your income at your next renewal, usually every 12 months. If your income exceeds the limit, your Medicaid coverage will end. You will then need to find other coverage, such as a Medicare Advantage plan or a private plan through the Health Insurance Marketplace. Report income changes promptly so there are no surprises at renewal.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.