Medicare and Medicaid are separate programs with different enrollment paths

Medicare is a federal health insurance program for people 65 and older, regardless of income. You enroll through Social Security. Medicaid is a joint federal-state program for people with lower incomes; you enroll through your state. The two programs can overlap — you may be covered by both — but the enrollment process for each is different, and the important date matter.

If you are turning 65 soon, you will handle Medicare enrollment. If you have a lower income and need coverage before 65, you will look at Medicaid through your state. Some people do both at the same time. This guide walks you through each path and what happens if you miss a important date.

Key Takeaways

  • Medicare enrollment begins 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 — by phone at 1-800-772-1213, online at ssa.gov, or in person at a local Social Security office.
  • Medicaid enrollment happens through your state health department or marketplace, and income limits and covered services vary by state.
  • If you are already receiving Social Security benefits when you turn 65, Medicare enrollment happens automatically, but you should still review your coverage choices.
  • Some people may have access to for both Medicare and Medicaid (called "dual may be able to access"); your state Medicaid program coordinates with Medicare to avoid duplicate coverage.

How Medicare enrollment works and when to start

Medicare enrollment opens during your Initial Enrollment Period (IEP), which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. For example, if you turn 65 in June, your IEP runs from March through September.

You must enroll during this window to avoid a late enrollment penalty — a permanent increase to your Part B and Part D premiums that stays with you for life. The penalty is 10 percent of the Part B premium for each year you delayed, and 1 percent of the Part D premium for each month you delayed. If you miss your IEP and do not have other may have access to coverage (such as employer health insurance), you cannot enroll again until the next General Enrollment Period, which runs January 1 through March 31 each year.

If you are already receiving Social Security retirement, disability, or Railroad Retirement Board benefits when you turn 65, Medicare enrollment happens automatically. You will receive your Medicare card in the mail about two weeks before your 65th birthday. You do not need to do anything, but you should still review the coverage options to make sure they fit your needs.

Enrolling in Medicare through Social Security

You have three ways to enroll in Medicare:

  1. Online at ssa.gov: Go to the Social Security website, sign in with your account (or create one), and follow the Medicare enrollment steps. This is the fastest route if you are comfortable online.
  2. By phone: Call Social Security at 1-800-772-1213, Monday through Friday, 7 a.m. to 7 p.m. local time. Have your Social Security number and birth certificate information ready. Wait times are often shorter early in the morning.
  3. In person: Visit your local Social Security office. You can find the nearest one at ssa.gov/locator. Bring your Social Security card, birth certificate, and proof of citizenship or legal residency (passport, naturalization papers, or state ID).

When you enroll, you will choose your coverage. Part A (hospital insurance) is automatic and free for most people. Part B (doctor and outpatient services) requires a monthly premium and an active choice to enroll. Part D (prescription drug coverage) is optional but recommended; if you do not enroll and later need it, you may face a penalty. You can also choose between Original Medicare (Parts A and B) plus a separate Medigap or Part D plan, or a Medicare Advantage plan (Part C), which bundles hospital, doctor, and drug coverage into one plan.

Understanding Medicaid and state-by-state differences

Medicaid is run by each state, so the income limits, covered services, and enrollment process vary. Some states have expanded Medicaid to cover adults earning up to 138 percent of the federal poverty level; others have not. Some states cover dental and vision; others do not. You must enroll through your state, not through a federal office.

To find your state Medicaid program, visit medicaid.gov and select your state from the map. You will be directed to your state health department or marketplace website. Some states use Healthcare.gov (the federal marketplace); others run their own enrollment sites. The website will tell you the income limits for your state and walk you through the enrollment process.

You will need to provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or legal residency, and proof of your state residency. Processing times vary by state but typically take two to four weeks. Some states process applications faster if you enroll online rather than by mail or phone.

If you may have access to for both Medicare and Medicaid

If your income is low enough to may have access to for Medicaid and you are 65 or older (or disabled and on Medicare), you are dual may be able to access. Both programs will cover you, but they coordinate to avoid paying twice for the same service. Medicare pays first, and Medicaid pays the remaining cost-sharing (copays, coinsurance, deductibles) that Medicare does not cover.

You must enroll in both programs separately. Enroll in Medicare through Social Security during your Initial Enrollment Period. Then enroll in Medicaid through your state. Tell your state Medicaid program that you have Medicare; they will adjust your Medicaid coverage to work alongside it. Some states have special programs for dual-may be able to access people that offer additional benefits like dental or vision coverage.

If you are already on Medicaid when you turn 65, you still must enroll in Medicare Part A and Part B. Do not assume Medicaid will cover you after 65; it will not unless you also have Medicare. Contact your state Medicaid program and Social Security at the same time to make sure both enrollments happen.

What to do if you missed your Medicare enrollment important date

If you are past your Initial Enrollment Period and did not enroll in Medicare, you have limited options. You can enroll during the General Enrollment Period (January 1 through March 31 each year), but coverage does not start until July 1 of that year, and you will owe a late enrollment penalty on your premiums for as long as you have Medicare.

There is one exception: if you had other may have access to coverage (such as employer health insurance or TRICARE) when you turned 65, you may have a Special Enrollment Period that lets you enroll without penalty. You must enroll within eight months of losing that coverage. Bring proof of your previous coverage — a letter from your employer's benefits office or a copy of your insurance card — when you enroll.

If you are unsure whether you had may have access to coverage, contact Social Security before you enroll. They can review your situation and tell you whether a penalty will explore.

Documents and information you will need

Before you start either enrollment, gather these items:

  • Your Social Security number
  • Your birth certificate or other proof of birth date
  • Proof of citizenship or legal residency (passport, naturalization papers, or state ID)
  • Proof of income (for Medicaid only): recent pay stubs, tax returns, or a letter from your employer stating your annual income
  • Proof of state residency (for Medicaid only): utility bill, lease, or mortgage statement with your name and current address
  • A list of any current medications and the names and addresses of your doctors (helpful but not required)

If you are enrolling online, you can upload documents or type in the information. If you are enrolling by phone or in person, have these items ready to reference. If you do not have a birth certificate, Social Security can help you get one; ask when you call.

Frequently Asked Questions

What happens if I turn 65 while still working?

You still must enroll in Medicare during your Initial Enrollment Period, even if you have employer health insurance. Your employer coverage does not count as may have access to coverage that lets you delay Medicare. However, if your employer has 20 or more employees, your employer plan pays first, and Medicare pays second. Enroll in Medicare to avoid a penalty, then coordinate with your employer's benefits office about how the two plans work together.

Can I enroll in Medicaid and Medicare at the same time?

Yes. You can explore to both programs at the same time, but you must do so through two separate processes. Start with Medicare through Social Security during your Initial Enrollment Period. Then explore to Medicaid through your state. Your state will coordinate the two programs once both are active. There is no single process that covers both.

Do I have to pay for Medicare Part A?

Most people do not. If you or your spouse paid Medicare taxes for at least 10 years while working, Part A is free. If you did not work long enough, you may have to pay a monthly premium. Social Security will tell you the cost when you enroll. If you cannot afford it, your state Medicaid program may pay the premium for you if you are dual may be able to access.

What if my state did not expand Medicaid?

If you are under 65 and your state did not expand Medicaid, you may not may have access to for Medicaid based on income alone. You may still may have access to if you are pregnant, disabled, a parent of a dependent child, or over 65. Check your state's Medicaid website or call 211 to speak with a benefits counselor who can tell you what you may have access to for in your state.

How long does it take to get my Medicare card?

If you enroll online or by phone, Social Security mails your card within two weeks. If you enroll in person, it may take up to four weeks. You do not need the card to start coverage; coverage begins on the first day of the month you turn 65 (or the month after you enroll, if you enroll after your birthday). You can check the status of your card online at ssa.gov.