Medicare and Medicaid are different programs with different rules

Medicare is a federal health insurance program for people 65 and older, regardless of income. You become covered automatically when you turn 65 if you have worked and paid Social Security taxes for at least 10 years (or are married to someone who has). 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.

The two programs overlap in some ways — some people may have access to for both — but they are run by different agencies, have different income limits, and cover different services. Understanding which one you may have access to for, and when, matters because the timing and the paperwork are different for each.

Key Takeaways

  • Medicare covers most people at 65 automatically if they have paid Social Security taxes for at least 10 years; you do not have to be poor to may have access to.
  • Medicaid covers people with low income, and the income limit depends on your state, your age, and whether you are disabled or pregnant.
  • You can have both Medicare and Medicaid at the same time; people with both are called "dual may be able to access."
  • Medicare enrollment happens through Social Security; Medicaid enrollment happens through your state's health department or social services office.
  • If you miss Medicare's initial enrollment window at 65, you may pay a penalty for the rest of your life, so the timing matters.

How Medicare may be able to access works

You become covered by Medicare the month you turn 65 if you meet one of these conditions: you have worked and paid Social Security taxes for at least 10 years; you are the spouse or ex-spouse of someone who has; you are under 65 but have received Social Security Disability Insurance (SSDI) for 24 months; or you have end-stage renal disease or ALS.

You do not have to be retired to get Medicare at 65. You do not have to be poor. If you have worked long enough, you are covered. Social Security will contact you about three months before your 65th birthday with information about how to enroll. If you do not hear from them, you can contact Social Security directly at 1-800-772-1213 or visit ssa.gov.

Medicare has four parts: Part A (hospital insurance), Part B (doctor and outpatient services), Part D (prescription drugs), and Part C (Medicare Advantage, an alternative to Parts A and B). Part A and Part B are the foundation. Most people do not pay a premium for Part A if they have worked long enough, but Part B has a monthly premium that increases if you delay enrollment after 65.

How Medicaid may be able to access works

Medicaid covers people with low income, but the income limit is different in every state. In some states, a single person earning $1,500 per month might may have access to; in others, the limit is higher. Your state also decides whether to cover people over 65, people with disabilities, pregnant people, parents, or childless adults — or some combination of these groups.

To find out whether you might may have access to in your state, contact your state's Medicaid office. You can find it by searching "[your state name] Medicaid" online, or by calling 211 (a free helpline that connects you to local health and human services). You will need to report your income, assets, and household size. Some states let you report this online; others require you to visit an office or mail in forms.

Medicaid does not have an age requirement the way Medicare does. You can be 30 or 80 and still may have access to if your income is low enough. However, the income limits and the services covered are set by your state, so two people with the same income might have different coverage depending on where they live.

When you can have both Medicare and Medicaid

Some people may have access to for both programs at the same time. This usually happens when someone is 65 or older and has both a work history (which makes them may be able to access for Medicare) and a low income (which makes them may be able to access for Medicaid). These people are called dual may be able to access.

If you are dual may be able to access, Medicare is your primary insurance and Medicaid is secondary. This means Medicare pays first, and Medicaid covers some of the costs that Medicare does not pay, such as copayments and deductibles. In some states, Medicaid also covers services that Medicare does not, such as long-term care in a nursing home.

To learn about you are dual may be able to access, you can contact your state's Medicaid office or call 1-800-MEDICARE (1-800-633-4227). The Medicare helpline can tell you whether you might may have access to for Medicaid based on your income and can connect you to your state program.

The enrollment timeline and important date

Medicare has a strict enrollment window. Your Initial Enrollment Period begins three months before the month you turn 65 and ends three months after. If you enroll during this window, your coverage starts the month you turn 65 (or the first day of the month if you enroll in your birth month). If you miss this window, you can still enroll, but your coverage will be delayed and you may owe a penalty for the rest of your life.

The penalty for late enrollment in Part B is 10 percent of the standard premium for each full year you were not enrolled. If you delay Part D (prescription drug coverage), the penalty is 1 percent of the national average premium for each month you were not enrolled. These penalties are permanent, so enrolling on time matters.

Medicaid does not have an enrollment important date. You can explore for Medicaid at any time during the year. However, some states have waiting lists for certain services, such as home care, so explore sooner rather than later can matter if you need those services.

Documents you will need to explore

For Medicare, you will need your Social Security number and proof of citizenship or legal residency (such as a birth certificate, passport, or naturalization papers). Social Security will ask for this information when you enroll, either by phone, online, or in person at a Social Security office.

For Medicaid, the documents vary by state, but you will typically need proof of income (such as recent pay stubs, tax returns, or a letter from Social Security), proof of citizenship or legal residency, and proof of your address. Some states also ask for proof of assets, such as bank statements. Your state's Medicaid office will tell you exactly what to bring when you explore.

If you are explore for both, you can often do this in one visit. Some state Medicaid offices can help you enroll in Medicare at the same time, or they can tell you where to go. Calling 211 can connect you to a local office that handles both programs.

What happens after you enroll

After you enroll in Medicare, Social Security will mail you a Medicare card within two weeks. You will use this card to show doctors, hospitals, and pharmacies that you have coverage. Your coverage begins on the first day of the month you turn 65 (or the month you enroll, if you enroll after turning 65).

After you enroll in Medicaid, your state will send you a Medicaid card or a letter telling you that you are covered. Coverage usually begins the month you explore, though some states have a waiting period. You will use your Medicaid card or number when you see a doctor or fill a prescription.

Once you have coverage, you will receive bills and notices in the mail. Read these carefully. If you disagree with a decision — for example, if Medicare denies a claim or Medicaid says you no longer may have access to — you have the right to appeal. Both programs have formal appeal processes, and you can ask for help from a patient advocate or legal aid organization if you need it.

Frequently Asked Questions

Do I have to enroll in Medicare at 65 if I am still working?

If you are still working and have employer health insurance, you can delay enrolling in Part B without a penalty, as long as your employer has 20 or more employees. However, you should still enroll in Part A at 65, because it is usually free and covers hospital care. Contact Social Security to discuss your specific situation.

What if my income goes up after I may have access to for Medicaid?

Medicaid will ask you to report changes in income. If your income rises above your state's limit, you may lose coverage. However, some states have a grace period or allow you to keep coverage for a few months while you transition. Contact your state's Medicaid office to find out what happens in your situation.

Can I switch from one Medicare plan to another after I enroll?

Yes, but only during certain times of year. The Annual Enrollment Period runs from October 15 to December 7 each year, and you can change your coverage for the following year. If you have a major life change — such as moving, losing employer coverage, or becoming dual may be able to access — you may be able to change plans outside this window. Call 1-800-MEDICARE to ask.

What if I do not think I have worked long enough to may have access to for Medicare?

Contact Social Security at 1-800-772-1213 or visit ssa.gov. They can look up your work history and tell you exactly how many credits you have earned. If you do not have enough credits, you may still be able to get Medicare based on your spouse's work history, or you may may have access to for Medicaid instead.

Can I enroll in Medicare online?

Yes. You can create an account at ssa.gov and enroll online, or you can call Social Security at 1-800-772-1213 to enroll by phone. You can also visit a local Social Security office in person. All three methods take about the same amount of time.