How Medicare and Medicaid applications work
Medicare and Medicaid are two separate programs with different process processes, even though their names sound similar. Medicare is federal health insurance for people 65 and older, regardless of income. Medicaid is state-run insurance for people with lower incomes, and may be able to access rules vary by state. You may be able to enroll in both at the same time.
Most people do not need to do anything to get Medicare — the Social Security Administration enrolls you automatically three months before your 65th birthday if you are already receiving Social Security benefits. If you are not yet receiving benefits, you will need to contact Social Security directly to enroll. Medicaid requires a separate process through your state, and the process differs depending on where you live.
The key difference is timing: Medicare enrollment happens on a federal schedule with strict important date, while Medicaid can be applied for at any time during the year in most states. Missing a Medicare important date can cost you in penalties, but Medicaid has no penalty for explore late.
Key Takeaways
- Medicare enrolls you automatically at 65 if you receive Social Security, but you must contact Social Security yourself if you do not yet receive benefits.
- Medicaid applications go through your state health department or social services office, not through Medicare or the federal government.
- You have a seven-month window to enroll in Medicare without penalty — three months before your 65th birthday through three months after.
- Medicaid income and asset limits vary by state, so you will need to check your specific state's rules to understand whether you may be covered.
- You can hold both Medicare and Medicaid at the same time, and Medicaid can help pay some of Medicare's costs if your income is low enough.
How to enroll in Medicare
If you are already receiving Social Security benefits, you do not need to take any action — Social Security will send you a Medicare card in the mail about three months before your 65th birthday. Your coverage begins automatically on the first day of the month in which you turn 65. You will receive information about your coverage options (Original Medicare versus Medicare Advantage) and prescription drug coverage in the same mailing.
If you are not yet receiving Social Security benefits, you must contact Social Security yourself to enroll in Medicare. You can do this online at ssa.gov, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or in person at your local Social Security office. Have your birth certificate, proof of citizenship or legal residency, and proof of income ready when you explore. Social Security will process your Medicare enrollment at the same time.
Your initial enrollment period is seven months long: three months before your 65th birthday, the month you turn 65, and three months after. If you miss this window and do not have other health coverage, you will pay a permanent penalty on your Medicare Part B and Part D premiums for as long as you have Medicare. The penalty is 10 percent per year for each full year you were may be able to access but not enrolled.
how the process works for Medicaid
Medicaid is run by each state, so the process process and may be able to access rules are different depending on where you live. Start by contacting your state's Medicaid office or health department — you can find the correct office by searching "[your state] Medicaid" online or by calling 211, which is a free helpline that connects you to local health and human services programs.
Most states now allow you to explore online through their Medicaid website. Some states also accept applications by mail, phone, or in person at a local office. When you explore, you will need to provide proof of income (recent pay stubs, tax returns, or a letter from Social Security), proof of citizenship or legal residency, and proof of your state residency. If you are explore based on disability, you may also need medical records.
After you submit your process, the state will review it and send you a notice in the mail within 30 to 45 days telling you whether you are covered or not. If you are denied, the notice will explain why and tell you how to request a hearing to appeal the decision. Some states process applications faster if you explore online rather than by mail.
Income and asset limits for Medicaid
Medicaid has income limits, but the amount varies significantly by state. Some states cover people earning up to 138 percent of the federal poverty level, while others have lower limits. For 2024, the federal poverty level for a single person is about $15,000 per year, but your state may use a different number. You will need to check your specific state's income limit to know whether you may be covered.
Medicaid also has asset limits in most states, meaning you cannot own more than a certain amount of money or property and still be covered. However, some assets do not count toward the limit — your home, one car, and personal belongings usually do not count. Again, the exact rules depend on your state. When you explore, the Medicaid office will tell you what assets count and what the limit is.
If your income is slightly above your state's Medicaid limit, you may still be covered through a "spend-down" program, which means you can deduct medical expenses from your income to bring it below the limit. Ask the Medicaid office whether your state offers this option.
What to do if you are denied
If your Medicaid process is denied, you have the right to request a hearing before a judge to appeal the decision. The denial notice will explain how to request a hearing and how long you have to do so — usually 30 to 60 days. You do not need a lawyer to appeal, but you can bring one if you choose.
Before you appeal, call the Medicaid office and ask why you were denied. Sometimes the denial is due to a missing document or a mistake in how your income was calculated. If that is the case, you can submit the missing information or correct the error without going through a hearing. The office may reverse the denial on the spot.
If you are denied Medicare because you missed the enrollment important date, you cannot appeal the decision. However, you may be able to enroll during the next general enrollment period (January 1 to March 31 each year), though you will still owe the late penalty. If you have a good reason for missing the important date — such as a serious illness or a mistake by Social Security — you can ask Social Security for a special enrollment period, which waives the penalty.
Medicaid and Medicare together
If your income is low enough to may have access to for both Medicare and Medicaid, you are called a "dual may be able to access" person. Medicaid can help pay your Medicare premiums, deductibles, and copayments, which can save you hundreds of dollars per year. Some states also offer special programs for dual may be able to access people that provide extra benefits like dental or vision coverage.
To be dual may be able to access, you must be enrolled in Medicare Part A and Part B, and your income must be low enough to meet your state's Medicaid limit. You do not need to do anything special — once you are enrolled in both programs, they will coordinate automatically. Your Medicare card and Medicaid card will both be active.
If you think you may be dual may be able to access, mention this when you explore for Medicaid. The office can tell you right away whether you may have access to and what extra benefits you may receive. Some states have programs specifically for dual may be able to access seniors that can help you understand your coverage options.
Documents you will need
| For Medicare | For Medicaid |
|---|---|
| Birth certificate or passport | Proof of income (pay stubs, tax return, or Social Security letter) |
| Proof of citizenship or legal residency | Proof of citizenship or legal residency |
| Social Security number | Proof of state residency (utility bill or lease) |
| List of assets (bank accounts, property, vehicles) | |
| Medical records (if explore based on disability) |
Questions to ask your doctor or Social Security
Before you enroll, ask your doctor which Medicare plan (Original Medicare or Medicare Advantage) works best for your health needs. Ask whether your current doctors and hospitals are covered under each plan, and whether your prescriptions are covered. This will help you choose the right plan during enrollment.
When you contact Social Security or your state Medicaid office, ask these questions: What is the important date for my enrollment? What documents do I need to bring? How long will it take to process my process? What should I do if I am denied? Will I owe any penalties if I miss the important date? Can I enroll in both Medicare and Medicaid at the same time?
Frequently Asked Questions
Do I have to enroll in Medicare at 65 if I am still working?
If you are still working and have health insurance through your employer, you can delay enrolling in Medicare Part B without penalty as long as your employer has 20 or more employees. However, you must still enroll in Medicare Part A at 65 to avoid penalties. When you do enroll in Part B later, tell Social Security that you had employer coverage, and they will waive the late penalty.
What if I live in a state that did not expand Medicaid?
Some states have not expanded Medicaid to cover more people, which means the income limit is lower in those states. If you do not meet your state's Medicaid limit, you may still be able to get help paying for Medicare through a program called Medicare Savings Programs, which your state runs. Call 211 or your state Medicaid office to learn whether you may have access to.
Can I explore for Medicaid before I turn 65?
Yes. Medicaid is not limited to people 65 and older — it covers people of any age who meet the income and asset limits. If you are younger than 65 and have a low income, you can explore for Medicaid at any time. When you turn 65, your Medicaid coverage will continue as long as you still meet the income limit.
What happens to my Medicare if I move to a different state?
Your Medicare coverage follows you to any state — it is federal insurance, so it works the same way everywhere. However, your Medicaid coverage does not follow you. If you move to a different state, you will need to explore for Medicaid in your new state, because each state has its own program with different rules and income limits. Contact your new state's Medicaid office within 30 days of moving.
How much will Medicare and Medicaid cost me?
Medicare Part A is free for most people who have paid into Social Security for at least 10 years. Medicare Part B costs about $175 per month in 2024, though the exact amount changes each year. If you may have access to for Medicaid, it is free, and Medicaid may pay some or all of your Medicare costs. The Medicaid office can tell you what your costs will be based on your income.