Medicare and Medicaid are separate programs with different rules
Medicare is a federal health insurance program for people 65 and older, regardless of income. You become covered automatically at 65 if you have worked and paid Social Security taxes for at least 10 years. Medicaid is a joint federal and state program that covers people with low income, and the rules change depending on which state you live in.
Many people think they are the same program because the names are similar. They are not. You may have Medicare, Medicaid, both, or neither — it depends on your age and income. This guide walks you through how each one works and what you need to do to get coverage.
Key Takeaways
- Medicare starts automatically at 65 if you have paid Social Security taxes for 10 years; you do not have to do anything except be a U.S. citizen or permanent resident.
- Medicaid income limits and coverage rules vary by state, so you must check your state's program to know whether you may have access to.
- You can have both Medicare and Medicaid at the same time if your income is low enough; people with both are called "dual may be able to access."
- The Social Security Administration handles Medicare enrollment, while your state's Medicaid office handles Medicaid enrollment.
- If you miss the Medicare enrollment window at 65, you may pay a permanent penalty on your premiums, so timing matters.
How Medicare enrollment works at age 65
You do not have to fill out a form or call anyone to get Medicare at 65 if you are already receiving Social Security benefits. The Social Security Administration will enroll you automatically three months before your 65th birthday. You will receive a Medicare card in the mail.
If you are not yet receiving Social Security when you turn 65, you must contact Social Security to enroll. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your birth certificate, proof of citizenship or permanent residency, and proof of income (usually a recent tax return).
Medicare has four parts: Part A (hospital insurance), Part B (doctor and outpatient care), Part D (prescription drugs), and Part C (Medicare Advantage, an alternative to Parts A and B). Part A and Part B are standard; you choose whether to add Part D and whether to switch to Part C. Most people pay a monthly premium for Part B and Part D, though Part A is free for those who paid taxes for 10 years.
What to do if you are under 65 and need coverage
If you are younger than 65, you cannot get Medicare unless you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or you have end-stage renal disease or ALS. Otherwise, Medicaid is your main option if your income is low.
Some people under 65 may have access to for Medicare because they worked in government jobs that did not pay into Social Security. If that applies to you, contact Social Security to ask about coverage under the Government Pension Offset rules.
How Medicaid enrollment works and what your state requires
Medicaid is run by each state, so the income limits, covered services, and enrollment process are different in every state. There is no single national Medicaid process. Instead, you must contact your state's Medicaid office or explore through your state's health insurance marketplace.
To find your state's Medicaid office, go to medicaid.gov and select your state from the map. You will be directed to your state's program page, which lists phone numbers, online portals, and office locations. Some states let you start an process online; others require you to call or visit in person.
When you contact your state's Medicaid office, you will need to provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of residency (a utility bill or lease), proof of citizenship or permanent residency, and your Social Security number. Income limits vary widely — some states cover people earning up to 138% of the federal poverty level, while others cover only those earning 100% or less. Your state's office can tell you the exact limit and whether you may have access to based on your income.
Medicaid coverage for people already on Medicare
If you are 65 or older and have Medicare, you may also may have access to for Medicaid if your income and assets are low enough. This is called being "dual may be able to access." Medicaid will cover your Medicare premiums, deductibles, and copayments, which can save you hundreds of dollars per month.
To find out whether you may have access to for Medicaid while on Medicare, contact your state's Medicaid office using the same process described above. Income and asset limits for dual may be able to access people are lower than for younger people on Medicaid alone, so do not assume you do not may have access to just because your income seems too high. Your state's office can run the numbers for you.
Some states have special programs for dual may be able to access people, such as Medicare Savings Programs, which pay your Part B premium and sometimes your deductibles. Ask your state's Medicaid office whether you may have access to for one of these programs.
Timing and important date for Medicare enrollment
Medicare has an enrollment window called the Initial Enrollment Period (IEP), which runs for seven months: three months before your 65th birthday, the month you turn 65, and three months after. If you enroll during this window, your coverage starts on the first day of the month you turn 65 (or the month after, depending on when you enroll).
If you miss this window, you can still enroll, but your coverage will start later and you may pay a permanent penalty. For every 12 months you delay enrolling in Part B after your IEP ends, your premium increases by 10%. This penalty stays with you for life. For Part D, the penalty is 1% of the national average premium for every month you delay, also permanent.
There are exceptions: if you were covered by a group health plan through an employer when you turned 65, you have eight months after that coverage ends to enroll without penalty. If you are still working and covered by your employer's plan, tell your employer's benefits office that you are turning 65 so they can explain your options.
Documents you will need for each program
| Program | Documents Needed | Where to Submit |
|---|---|---|
| Medicare (at 65) | Birth certificate, proof of citizenship or permanent residency, proof of income (tax return or pay stub) | Social Security Administration online, by phone, or in person |
| Medicaid | Proof of income (pay stubs, tax returns, or employer letter), proof of residency (utility bill or lease), proof of citizenship or permanent residency, Social Security number | Your state's Medicaid office (found at medicaid.gov) |
| Medicare Savings Program (if dual may be able to access) | Medicare card, proof of income, proof of residency, Social Security number | Your state's Medicaid office |
Common mistakes to avoid
The biggest mistake is waiting until after 65 to enroll in Medicare. Even if you are still working and covered by an employer plan, you should enroll in Medicare at 65 to avoid the permanent penalty. Your employer plan will coordinate with Medicare, so you will not be double-insured.
Another common mistake is assuming you do not may have access to for Medicaid because you have Medicare. Many people over 65 with low income may have access to for both. The only way to know is to contact your state's Medicaid office and ask.
A third mistake is not choosing a Part D plan (prescription drug coverage) during the enrollment window. If you do not enroll in Part D when you first become may be able to access and you go without coverage, you will pay a penalty when you finally enroll. The penalty is 1% of the national average premium for every month you were without coverage.
Frequently Asked Questions
Do I have to pay for Medicare?
Part A (hospital insurance) is free if you or your spouse paid Social Security taxes for at least 10 years. Part B (doctor visits) costs about $175 per month in 2024, though the amount changes each year. Part D (prescription drugs) costs vary by plan. If you have Medicaid, it may pay your Part B premium.
What if I am not a U.S. citizen?
You must be a U.S. citizen or permanent resident to get Medicare or Medicaid. If you are a permanent resident, you will need to show your green card or other proof of permanent residency status when you enroll.
Can I switch from one Medicaid plan to another?
Yes, but the timing depends on your state. Most states allow you to change plans once a year during the open enrollment period, which usually runs from November through December. Some states allow changes if your life circumstances change, such as a move or job loss. Contact your state's Medicaid office to ask when you can switch.
What happens to my Medicare if I move to a different state?
Medicare coverage follows you across state lines — your Medicare card works the same way in every state. However, your Medicaid coverage does not. If you move to a new state, you must contact that state's Medicaid office to see whether you still may have access to under the new state's rules, which may be different.
How long does it take to get Medicaid coverage after I explore?
Most states aim to make a decision within 30 to 45 days, though some take longer. Contact your state's Medicaid office to ask how long the current wait is. In the meantime, keep copies of everything you submit so you can follow up if you do not hear back.