Medicare and Medicaid are separate programs with different rules
Medicare is a federal insurance program for people 65 and older, regardless of income. Medicaid is a joint federal-state program for people with low incomes, at any age. The names sound similar, but the path to each one is different, the income limits are different, and the coverage is different. Understanding which one you might use depends on your age and your income — and some people use both at the same time.
This guide explains who the programs are designed for, what the actual income and asset limits are in your situation, and how to find out whether you fall into either category. The rules vary by state for Medicaid, so the specific dollar amounts will depend on where you live.
Key Takeaways
- Medicare is for people 65 and older, and for some younger people with disabilities or end-stage renal disease, regardless of how much money they have.
- Medicaid is for people with low incomes and limited assets, at any age, but the income and asset limits vary by state.
- You can be on both Medicare and Medicaid at the same time — this is called being "dual may be able to access" — and many older adults are.
- To find out your state's Medicaid income limits, contact your state Medicaid office or call 211; to sign up for Medicare, you contact Social Security or Medicare directly.
- Missing the Medicare sign-up window when you turn 65 can result in permanent penalties on your premiums, so timing matters.
Medicare: Age 65 or disability
You become may be able to access for Medicare the month you turn 65, as long as you or your spouse paid into Social Security for at least 10 years (40 quarters). You do not have to be retired, and your income does not matter. If you were born on the first of the month, your coverage starts the month before.
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 rule.
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 A and B). Part A is free for most people. Part B and Part D have monthly premiums that vary based on your income. You pay these premiums to Medicare, not to the government as taxes.
Medicaid: Low income and assets
Medicaid covers people of any age whose income and assets fall below their state's limits. The income threshold varies widely — a single adult might may have access to with a monthly income of $1,000 in one state and $2,000 in another. Asset limits also vary: some states count a car and a home as assets that count against you, others do not. A few states have no asset limit at all.
To find your state's current limits, contact your state Medicaid office directly or call 211 and ask for Medicaid information. Do not rely on numbers from another state or from last year — these change, and your state's rules are the only ones that matter for your situation.
Medicaid covers hospital care, doctor visits, prescription drugs, and long-term care (nursing home or home care), depending on your state. Some states are more generous than others. If you are on Medicaid and turn 65, you stay on Medicaid — you do not lose it when you become may be able to access for Medicare.
Being on both Medicare and Medicaid at the same time
If your income is low enough to meet your state's Medicaid limit and you are 65 or older (or disabled and on Medicare), you can be on both programs. This is called being dual may be able to access. Medicare pays first, then Medicaid covers what Medicare does not pay, including Medicare premiums and cost-sharing.
Dual may be able to access people often pay nothing out of pocket for doctor visits, hospital stays, or prescriptions — Medicaid fills the gaps. This is one of the most valuable combinations available to older adults with low incomes. If you think you might may have access to for Medicaid, it is worth checking, even if you are already on Medicare.
To explore whether you may have access to for Medicaid while on Medicare, contact your state Medicaid office or call 211. They can tell you the income and asset limits for your state and walk you through what you need to report.
Income and asset limits by state
Medicaid income limits are set by each state and change yearly. As of 2024, most states use a threshold between 100% and 200% of the federal poverty level for adults, but some states are higher and some are lower. For a single adult, 100% of the federal poverty level is roughly $1,150 per month; 200% is roughly $2,300 per month. Your state may be above or below this range.
Asset limits also vary. Some states count only liquid assets (bank accounts, stocks) and ignore a home and one car. Other states count everything. A few states have removed asset limits entirely for certain groups. The only way to know your state's rules is to ask your state Medicaid office or 211.
| Program | Age or Disability Requirement | Income Limit | Asset Limit |
|---|---|---|---|
| Medicare | 65 or older; or disabled 24+ months; or end-stage renal disease | None | None |
| Medicaid | Any age | Varies by state (typically 100–200% of federal poverty level) | Varies by state (some states have no limit) |
| Dual may be able to access | 65 or older, or disabled and on Medicare | Must meet state Medicaid limit | Must meet state Medicaid limit |
How to learn about you may have access to
For Medicare: If you are 65 or older, you are almost certainly may be able to access. Contact Social Security at 1-800-772-1213 or visit ssa.gov to confirm your work history and start your coverage. If you are under 65 and have been on Social Security disability for 24 months, Medicare starts automatically — you do not have to do anything.
For Medicaid: Call your state Medicaid office or call 211 and say you want to know about Medicaid. Have your most recent pay stubs, tax return, and a list of your bank accounts and savings ready. They will tell you the income and asset limits for your state and whether you meet them. Many states now let you start the process online through your state's health insurance marketplace.
If you are already on Medicare and think you might may have access to for Medicaid, explore anyway. Being on Medicare does not disqualify you from Medicaid. Many people are on both and do not realize it.
Common mistakes and timing issues
The biggest mistake with Medicare is missing the sign-up window. You have seven months to sign up: three months before you turn 65, the month you turn 65, and three months after. If you miss this window and do not have other health coverage, you pay a permanent 10% penalty on your Part B premium for every year you are late. This penalty stays with you for life, so the cost of missing the important date is real.
With Medicaid, the mistake is assuming you do not may have access to because you have a job or own a home. Medicaid rules are more flexible than many people think. Some states count only part of your income, some ignore home equity, and some have special rules for working people. The only way to know is to ask.
Another common mistake is not reapplying for Medicaid after a change in income. If your income drops, you may now may have access to. If you were denied before, your situation may have changed. Medicaid rules and income limits also change yearly, so something that disqualified you last year might not this year.
Frequently Asked Questions
Can I get Medicare if I have not worked long enough?
If you have not paid into Social Security for 10 years, you cannot get free Part A (hospital insurance). You can still buy Part A if you are 65 or older, but the premium is higher. Contact Social Security to find out exactly how many quarters you have paid in and what your options are.
What if my income is too high for Medicaid but too low for Medicare premiums?
Some states offer programs for people in this gap. Ask your state Medicaid office or 211 about "spend-down" programs, where you can reduce your countable income by paying medical bills. Some states also have special programs for working people with disabilities or for people who are medically needy.
Do I have to choose between Medicare and Medicaid?
No. If you meet the requirements for both, you can be on both at the same time. Medicaid will cover your Medicare premiums and fill in the gaps Medicare does not cover. This is one of the best outcomes for people with low incomes and high medical needs.
What happens to my Medicaid when I turn 65 and get Medicare?
You do not lose Medicaid when you turn 65. If you were on Medicaid before 65, you stay on it as long as you still meet the income and asset limits. If you were not on Medicaid before, you can explore when you turn 65 if your income now qualifies.
How do I know if my state's Medicaid rules are different from another state?
They almost certainly are. Medicaid is run by each state, so income limits, asset limits, covered services, and process processes all vary. Never use another state's numbers or rules. Call your state Medicaid office or 211 to get your state's specific information.