Medicare and Medicaid Are Two Separate Programs With Different Rules

Medicare is a federal insurance program you enter when you turn 65, regardless of income. 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. They are not the same program, they do not have the same requirements, and you can be on both at the same time.

Most people think of Medicare as "for seniors" and Medicaid as "for poor people," and while those descriptions point in the right direction, they miss the real boundaries. You can be 55 and on Medicaid. You can be 75 and ineligible for Medicaid because your income is too high. You can be 68 and on both programs simultaneously. The rules for each are separate, and understanding which one you might be on — or both — requires knowing what each program actually measures.

Key Takeaways

  • Medicare is available to anyone 65 or older, regardless of income, plus some younger people with disabilities or end-stage renal disease.
  • Medicaid is available to people with low income and assets, but the income and asset limits vary significantly by state.
  • You can be on Medicare and Medicaid at the same time; people on both are called "dual may be able to access."
  • You do not automatically get Medicare at 65 — you must sign up during your enrollment window or face late penalties.
  • Medicaid coverage starts on the first day of the month you are found to meet the rules, not the day you submit your paperwork.

Who Gets Medicare: Age, Disability, and Kidney Disease

You are may be able to access for Medicare if you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years. You do not have to be retired, and your income does not matter. If you have been paying into Social Security through payroll taxes for at least 10 years (40 quarters), you get Medicare Part A and Part B with no monthly premium for Part A. If you have not worked that long, you can still buy into Medicare, but you will pay a premium for Part A.

You can also get Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). These are the only exceptions to the age 65 rule.

Medicare has four parts: Part A covers hospital stays and some skilled nursing care; Part B covers doctor visits and outpatient services; Part D covers prescription drugs; and Part C (Medicare Advantage) is an alternative to Parts A, B, and D offered by private insurers. You must sign up during your enrollment window — usually the three months before, the month of, and the three months after your 65th birthday. If you miss that window and do not have other health coverage, you pay a penalty for every month you delay.

Who Gets Medicaid: Income and Asset Limits That Vary by State

Medicaid is for people with low income and low assets. The federal government sets a floor — states cannot be more restrictive than federal minimums — but most states have set their own higher income limits. This means a person with the same income might be on Medicaid in one state and ineligible in another.

Generally, Medicaid covers people whose income is at or below 138 percent of the federal poverty line, though some states have set lower limits and a few have set higher ones. For 2024, the federal poverty line for a single person is approximately $14,600 per year; for a family of three, approximately $30,000. But your state's Medicaid program may use a different number. You need to check your state's specific rules.

Asset limits also vary by state. Most states count cash, bank accounts, and some investments toward an asset limit, but they do not count your home, your car, or your household goods. Some states have no asset limit at all. If you are over the asset limit in your state, you may still be able to spend down — use your money on allowed expenses like medical bills or home repairs — to become may be able to access.

Medicaid also covers some people who are not low-income: pregnant people, children up to age 19 in most states, and people who are blind or disabled. The income rules for these groups are often higher than for working-age adults without disabilities.

When You Can Be on Both Medicare and Medicaid

If you are 65 or older and your income and assets are low enough to meet your state's Medicaid rules, you can be on both programs. People on both are called dual may be able to access or dually may be able to access. Medicare is your primary insurance, and Medicaid fills in gaps — it covers Medicare premiums, copays, and deductibles, and it may cover services Medicare does not, like long-term care in a nursing home.

Being dual may be able to access usually means you pay less out of pocket than you would on Medicare alone. However, your state may require you to join a Medicare Advantage plan or a special Medicaid managed care plan for dual-may be able to access people, which limits which doctors and hospitals you can use. Check with your state Medicaid office about whether you have a choice.

How to Find Out Your State's Medicaid Rules

Because Medicaid rules are set by each state, the only way to know whether you meet your state's income and asset limits is to contact your state Medicaid office directly or use your state's online screening tool. You can find your state Medicaid office through the Centers for Medicare & Medicaid Services website or by calling 211, which connects you to local health and human services programs.

When you contact your state Medicaid office, have ready your most recent tax return or pay stubs, bank statements, and a list of any assets you own. They will tell you whether your income and assets fall within the limits and what documents you need to submit if you want to move forward.

What Happens After You Meet the Rules

For Medicare, once you turn 65, you sign up during your enrollment window. Your coverage begins on the first day of the month you turn 65 (or the first day of the month after you sign up, if you sign up late). You will receive a Medicare card in the mail.

For Medicaid, once you submit your paperwork and your state determines you meet the rules, your coverage typically begins on the first day of the month you are found to be may be able to access. This is not the day you submit your paperwork — it is the day the state officially approves you. Some states have a waiting period; others do not. Your state will tell you the exact date your coverage starts.

After you are on either program, you are responsible for paying any premiums, copays, or deductibles that the program does not cover. If your income or assets change, you must report the change to the program, because it may affect whether you stay may be able to access.

Common Mistakes That Delay or Block Coverage

The most common Medicare mistake is not signing up at 65. If you are still working and have health coverage through your employer, you can delay Medicare Part B without penalty, but you must sign up for Part A. If you do not, and you later try to sign up, you will owe a penalty for every month you delayed.

The most common Medicaid mistake is not reporting a change in income or assets. If you receive a raise, inherit money, or sell a house, you must tell your state Medicaid office. If you do not, and the state later discovers you were over the limit, you may have to repay benefits you received while ineligible.

Another common mistake is confusing the two programs and thinking you are on one when you are on the other. If you are 65 and on Medicaid, you are not automatically on Medicare — you must sign up for Medicare separately. If you are on Medicare, you are not automatically on Medicaid — you must explore to your state Medicaid office.

Frequently Asked Questions

Can I get Medicare if I am not a U.S. citizen?

You must be a U.S. citizen or permanent resident who has lived in the country for at least five years. If you are a permanent resident, you will need to show your green card or other proof of status when you sign up.

What if my income is just above my state's Medicaid limit?

Some states have programs for people just above the Medicaid income limit. Your state Medicaid office can tell you whether you may have access to for a spend-down program or a related coverage option. You can also ask about Medicare Savings Programs, which help pay Medicare premiums and cost-sharing for people with income up to 200 percent of the federal poverty line.

Do I have to sign up for Medicare Part D if I am on Medicaid?

If you are on Medicaid, your state covers prescription drugs through Medicaid, so you do not need to sign up for Medicare Part D. However, if you lose Medicaid coverage, you should sign up for Part D within 63 days to avoid a late penalty.

Can I be on Medicaid in one state and Medicare in another?

Medicare is federal, so it follows you across state lines. Medicaid is state-based, so if you move, you must explore for Medicaid in your new state. Your old state's Medicaid coverage ends when you move.

What if I turn 65 while I am on Medicaid?

You stay on Medicaid as long as you still meet your state's income and asset rules. You must also sign up for Medicare at 65. Once you are on both, Medicare is your primary insurance and Medicaid covers the gaps.