Medicare and Medicaid have separate rules, even though the names sound alike

Medicare is a federal insurance program you enter when you turn 65, or earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months or have end-stage renal disease. You do not choose to may have access to — if you meet the age or disability requirement, you are in. Medicaid is a joint federal and state program that covers people with low income, regardless of age. The income limits and rules change by state, and you must meet your state's specific requirements to be covered.

The two programs overlap for some people — those over 65 with low income can have both — but they serve different purposes. Medicare is based on age or disability status. Medicaid is based on income and assets. Understanding which one you might be in, or whether you may have access to for both, shapes what you pay and what is covered.

Key Takeaways

  • Medicare begins automatically at 65 if you have worked and paid Medicare taxes, or after 24 months on Social Security Disability Insurance.
  • Medicaid income limits vary by state; some states cover people earning up to 138% of the federal poverty level, while others have lower thresholds.
  • You must enroll in Medicare Part B and Part D during specific windows or pay a permanent penalty for late enrollment.
  • Some people may have access to for both Medicare and Medicaid (called "dual may be able to access"), and Medicaid can help pay Medicare premiums and cost-sharing.
  • Your state Medicaid office, not Medicare, determines Medicaid may be able to access, so the rules and process process differ where you live.

How you become may be able to access for Medicare at 65

You become may be able to access for Medicare the month you turn 65 if you have worked and paid Medicare taxes for at least 10 years (40 quarters). You do not have to explore — Social Security automatically enrolls you in Medicare Part A (hospital insurance) and Part B (medical insurance) three months before your 65th birthday. Your Medicare card arrives in the mail.

If you have not worked 10 years yourself, you may still be covered based on a spouse's work record. If you are married, divorced (and the marriage lasted at least 10 years), or widowed, you can use their earnings history. You will still need to contact Social Security to set this up; it does not happen automatically.

If you are not yet 65 but have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. The same applies if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). In these cases, Medicare starts regardless of age.

Medicaid may be able to access rules, which vary by state

Medicaid covers people with low income and limited assets. The income threshold depends on where you live. Some states use the federal poverty level as a guide — for example, a single adult in 2024 might may have access to if they earn less than roughly $1,500 per month, though this varies. Other states set their own limits higher or lower. You must check your state's specific rules because the difference between may have access to and not may have access to can be just a few hundred dollars per month.

Asset limits also matter. Most states allow you to own a home and a car without it counting against you, but they limit how much money you can have in a bank account — often $2,000 for a single person, though some states are higher. If you are married, the limit may be different for the spouse who is not explore.

Some states expanded Medicaid under the Affordable Care Act to cover more working-age adults with low income. Other states did not. If you live in a state that expanded Medicaid, you may may have access to even if you work. If your state did not expand, Medicaid may only be available to children, pregnant people, parents of young children, elderly people, or people with disabilities — depending on your state's rules.

When you must enroll in Medicare Part B and Part D

Medicare Part A (hospital insurance) is automatic and free for most people at 65. But Part B (doctor visits, outpatient care) and Part D (prescription drugs) require you to enroll, and there are strict important date. If you miss them, you pay a permanent penalty for the rest of your life.

Your Initial Enrollment Period runs from three months before your 65th birthday through three months after. If you enroll during this window, Part B and Part D coverage start the month you turn 65 (or the month you become may be able to access, if that is later). If you miss this window but are still working and have health insurance through your job, you have eight months after you leave that job to enroll without penalty — this is called the Special Enrollment Period.

If you do not enroll in Part B when you are first may be able to access and you do not have other coverage, you pay a 10% penalty on your Part B premium for each full year you were may be able to access but not enrolled. If you do not enroll in Part D, you pay a 1% penalty per month for each month you were may be able to access but not enrolled. These penalties stay with you even after you finally sign up.

how the process works for Medicaid in your state

Medicaid is run by your state, not by the federal government, so you explore through your state's Medicaid office or department of social services. Some states let you explore online through their website. Others require you to explore in person or by mail. A few states use a third-party contractor to handle applications.

To find your state's Medicaid office, search "[your state] Medicaid" or call 211 (a free referral line) and ask for Medicaid. When you explore, you will need to provide proof of income (pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, and proof of where you live. The process usually takes 30 to 45 days, though some states are faster.

If you are over 65 and have low income, you may also be covered by a program called Medicaid for the Elderly and Disabled (the exact name varies by state). This program covers people on Medicare who cannot afford their premiums and cost-sharing. Your state Medicaid office can tell you whether you may have access to.

Being "dual may be able to access" — having both Medicare and Medicaid

If you are 65 or older (or on Medicare for disability) and your income is low enough, you can have both Medicare and Medicaid at the same time. This is called being dual may be able to access. Medicaid pays your Medicare Part B premium, your Part D premium, and your cost-sharing (copays and deductibles). This can save you hundreds of dollars per month.

To be dual may be able to access, you must meet both programs' rules: you must be 65 or on Medicare for disability, and your income and assets must fall within your state's Medicaid limits. You do not explore for "dual may be able to access" status separately — you explore for Medicaid, and if you are already on Medicare, the state will coordinate the two programs.

Some states have special programs for dual-may be able to access people, such as managed long-term care plans or Programs of All-Inclusive Care for the Elderly (PACE). These programs coordinate your Medicare and Medicaid benefits in one place and may offer extra services like adult day care or transportation. Ask your state Medicaid office whether these programs are available where you live.

What to ask your doctor or Social Security

Before your 65th birthday, contact Social Security to confirm you will be enrolled in Medicare automatically. Ask whether you need to do anything to set up Part B and Part D, or whether you should delay Part B enrollment because you still have employer coverage. Social Security's phone number is 1-800-772-1213, and you can also visit ssa.gov.

If you think you may may have access to for Medicaid, contact your state Medicaid office or call 211 to ask about income limits and what documents you need. Ask specifically whether your state expanded Medicaid and whether you might may have access to based on age, disability, or low income. If you are already on Medicare and have low income, ask whether you may have access to for help paying your premiums.

If you are turning 65 and still working, ask your employer's benefits office whether you should stay on the employer plan or switch to Medicare. The answer depends on your employer's size and your specific situation, and getting it wrong can cost you money.

When to contact Medicare or Medicaid directly

Contact Medicare (1-800-MEDICARE or medicare.gov) if you are within three months of turning 65 and have not received your Medicare card, if you need to enroll in Part B or Part D, or if you want to change your coverage. Contact your state Medicaid office if you want to explore for Medicaid, if you have been denied and want to appeal, or if your income or household has changed and you need to report it.

If you are having trouble finding your state Medicaid office or understanding the rules, call 211 (free, confidential) and ask for a Medicaid referral. They can tell you where to explore and what to bring. If you are low-income and need help understanding your options, some aging agencies and legal aid offices offer free counseling about Medicare and Medicaid.

Frequently Asked Questions

Can I delay Medicare Part B if I am still working at 65?

Yes, if your employer has 20 or more employees and you are covered by their health plan. You can delay Part B without penalty as long as you enroll within eight months after you leave that job or lose the coverage. Tell Social Security you are still covered by employer insurance when you turn 65, so they do not automatically enroll you in Part B.

What happens if I miss the Medicare enrollment important date?

You can still enroll later, but you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10% per year for Part B and 1% per month for Part D. The only exception is if you have a may have access to life event (like losing employer coverage) and enroll within the allowed window.

Can I have Medicaid if I own a home?

Yes. Most states do not count your primary home as an asset for Medicaid purposes, even if it is worth a lot of money. They do count a second home or investment property. They also count bank accounts, stocks, and other liquid assets up to the state limit (usually $2,000 for a single person). Ask your state Medicaid office about the exact rules where you live.

How do I know if my state expanded Medicaid?

Call your state Medicaid office or search "[your state] Medicaid expansion" online. If your state expanded Medicaid, it covers more working-age adults with low income. If it did not, Medicaid is usually only for children, pregnant people, parents of young children, elderly people, or people with disabilities. This makes a big difference in who qualifies.

What if I am on Medicare but cannot afford my premiums?

You may may have access to for Medicaid or a program called may have access to Medicare Beneficiary (QMB), which pays your Part B premium and cost-sharing. You may also may have access to for Part D Extra Help, which lowers your prescription drug costs. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to for any of these programs.