Medicare and Medicaid are separate programs with different rules

Medicare and Medicaid sound similar, but they work in completely different ways. Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). You become may be able to access for it mainly because of your age — you can enroll starting at 65 — or because you have been receiving Social Security Disability Insurance (SSDI) for 24 months. Medicaid is a joint federal and state program that pays for health care based on your income and assets. Each state runs its own Medicaid program with its own income limits and rules.

The key difference: Medicare is about who you are (your age or disability status). Medicaid is about how much money you have. You can have both at the same time — people who do are sometimes called "dual may be able to access" — but you get them through completely different processes and from different agencies.

Key Takeaways

  • Medicare enrollment starts three months before the month you turn 65; if you miss this window, you may pay a permanent penalty on your premiums.
  • You enroll in Medicare through Social Security (online at ssa.gov, by phone at 1-800-772-1213, or in person at a local Social Security office) or through Medicare.gov directly.
  • Medicaid income limits and rules vary by state, so you must contact your state's Medicaid office or use your state's online portal to learn what you may have access to for.
  • If you are under 65 and disabled, you may may have access to for Medicare after 24 months on SSDI, but Medicaid rules for disabled adults differ from rules for seniors.
  • explore for Medicaid usually happens through your state's health insurance marketplace or your state Medicaid office, not through Medicare.

How to enroll in Medicare at 65

You can start the Medicare enrollment process three months before the month you turn 65. For example, if you turn 65 in June, you can enroll starting in March. This is called your Initial Enrollment Period, and it lasts seven months total — three months before, the month you turn 65, and three months after.

The easiest way to enroll is online at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). You can also enroll in person at your local Social Security office. You will need your Social Security number, proof of citizenship (your birth certificate, passport, or naturalization papers), and proof of residency (a utility bill or lease). If you are still working and have health insurance through your job, bring that information too — it affects which Medicare parts you need to enroll in right away.

If you miss your Initial Enrollment Period, you can still enroll during the General Enrollment Period (January 1 through March 31 each year), but you may owe a permanent 10% increase on your Part B premiums for each year you were late. This penalty stays with you for life, so enrolling on time matters.

Medicare enrollment if you are under 65 and disabled

If you receive SSDI (Social Security Disability Insurance), you automatically become may be able to access for Medicare after you have been on SSDI for 24 months. You do not have to do anything — Social Security will enroll you automatically. You will receive your Medicare card in the mail about a month before your coverage starts.

Some people on SSDI also may have access to for Medicaid, depending on their state's rules. This is separate from Medicare and requires a separate process to your state Medicaid office. Do not assume that being on SSDI means you have Medicaid — you have to check with your state.

how the process works for Medicaid

Medicaid is run by each state, so the process and income limits are different everywhere. To find out whether you might may have access to and how the process works, you need to contact your state's Medicaid office directly. The fastest way is to search online for "[Your State] Medicaid" or "[Your State] health insurance marketplace."

Many states let you explore online through their health insurance marketplace. Some states use a separate Medicaid portal. A few still require you to explore by mail or in person. When you explore, you will need to report your income (from work, Social Security, pensions, or other sources), your assets (savings, property), and the number of people in your household. Medicaid counts income and assets differently than Medicare does, so having a certain amount of money might disqualify you in one state but not another.

After you explore, your state will send you a notice saying whether you may have access to. This can take anywhere from a few days to several weeks. If you are approved, your coverage usually starts on the first day of the month after you explore, though some states backdate coverage to the date you applied.

What to do if you are over 65 and think you need Medicaid

If you are already on Medicare and your income is very low, you may also may have access to for Medicaid. This is common for seniors living on only Social Security. Your state's Medicaid office will tell you the income limit — it varies widely. In some states, you can have a little over $1,000 per month and still may have access to; in others, the limit is higher.

Contact your state Medicaid office to explore. You will need to show proof of your income (Social Security statements, pension letters, bank statements) and proof of your assets. Some states have special programs for seniors with limited income and resources, such as Supplemental Security Income (SSI) programs, that make it easier to may have access to for Medicaid. Ask your state Medicaid office whether you might may have access to for one of these programs.

What happens if you are denied

If your state denies your Medicaid process, you have the right to appeal. The notice you receive will explain how to request an appeal and the important date to do so — usually 30 to 60 days. You can appeal on your own or ask for help from a legal aid organization or a patient advocate in your area.

If you are denied Medicare enrollment because you missed your important date, you cannot appeal the decision, but you can enroll during the General Enrollment Period (January through March) each year. You will owe the late penalty, but you can start coverage.

Frequently Asked Questions

Can I have both Medicare and Medicaid at the same time?

Yes. People who have both are called "dual may be able to access." Medicare is your primary insurance, and Medicaid helps pay costs that Medicare does not cover, like copays and deductibles. You explore for them separately — Medicare through Social Security or Medicare.gov, and Medicaid through your state.

What if I am still working at 65 — do I have to enroll in Medicare?

If you or your spouse are still working and have health insurance through that job, you can delay enrolling in Medicare Part B without penalty. You must still enroll in Part A (hospital insurance) at 65, but you can wait to enroll in Part B until you or your spouse stop working or lose the job-based coverage. Tell Medicare.gov or Social Security that you have job-based coverage so they know you are delaying on purpose.

How long does it take to learn about I may have access to for Medicaid?

Processing times vary by state. Some states decide within a few days; others take several weeks. Your state's Medicaid office or website will tell you the typical wait time. You can call to check the status of your process after you submit it.

What if my income changes after I am approved for Medicaid?

You must report changes in income to your state Medicaid office. If your income goes up and exceeds your state's limit, you may lose Medicaid coverage. If your income goes down, you may become may be able to access for more help. The rules about when and how to report changes differ by state, so check your approval letter or call your state Medicaid office.

Do I need a lawyer to explore for Medicare or Medicaid?

No. Both applications are designed for people to complete on their own. However, if your Medicaid process is denied and you want to appeal, a legal aid organization in your area can help you for free. Search online for "[Your State] legal aid" to find a local organization.