Medicare and Medicaid are different programs with different rules

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). You generally become covered at age 65, regardless of income. Medicaid is a joint federal and state program that covers people with lower incomes at any age. The two programs have separate income limits, age requirements, and rules about who can join. Some people have both — called "dual may be able to access" — but being may be able to access for one does not automatically mean you are may be able to access for the other.

Understanding which program you might use depends on your age, income, disability status, and which state you live in. Medicaid rules vary significantly by state, so a person who qualifies in one state may not may have access to in another. This guide explains the basic rules for each program and how to find out whether you meet the requirements in your situation.

Key Takeaways

  • Medicare covers most people at age 65 without an income test, but you must have worked and paid Medicare taxes for at least 10 years (or be a spouse or dependent of someone who did).
  • Medicaid covers people of any age with lower incomes, but the income limit depends on your state and family size.
  • You can have both Medicare and Medicaid at the same time; Medicaid can help pay Medicare premiums and out-of-pocket costs.
  • Some people under 65 may have access to for Medicare if they receive Social Security Disability Insurance (SSDI) for at least 24 months or have end-stage renal disease or ALS.
  • To find out your specific Medicaid income limit, contact your state Medicaid office or use the CMS Medicaid website to locate your state's rules.

Medicare may be able to access at age 65 and beyond

You become covered by Medicare at age 65 if you or your spouse paid Medicare taxes while working for at least 10 years (40 quarters). You do not need to be retired, and there is no income limit. If you were born on the first of the month, your coverage begins the month before you turn 65; otherwise it begins the month you turn 65.

If you are not yet 65 but receive Social Security Disability Insurance (SSDI), you become covered by Medicare after you have been on SSDI for 24 months. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you may be covered regardless of age. You can also be covered as a spouse or dependent of someone who meets the work requirement, even if you yourself did not work the required 10 years.

If you do not have the 10-year work history and are not a spouse or dependent, you can still purchase Medicare coverage at age 65 by paying a monthly premium. Contact Social Security or visit Medicare.gov to verify your work record and find out whether you may have access to.

Medicaid income limits vary by state and family size

Medicaid covers people with lower incomes, but the income threshold is different in every state. Some states use the federal poverty level as a guide; others set their own limits. A single person might may have access to in one state but not in another, even with the same income. Family size also matters — a household of four has a higher income limit than a household of one.

Most states expanded Medicaid in 2014 to cover adults earning up to 138% of the federal poverty level (about $18,000 per year for a single person in 2024, though this amount changes yearly). However, some states did not expand and have lower income limits. A few states cover only children, pregnant people, parents, and people with disabilities — not working-age adults without dependents.

To find your state's current income limit, visit the CMS Medicaid website at medicaid.gov, select your state, and look for "income limits" or "who is covered". You can also call your state Medicaid office directly; the number is listed on your state health department website.

Medicaid for people under 65 with disabilities

Medicaid covers people under 65 who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). SSI is a needs-based program for people with disabilities, blindness, or age 65 and older with very low income and few assets. SSDI is based on your own work history or your parent's work history if you became disabled before age 22.

If you receive either SSI or SSDI, you are automatically covered by Medicaid in most states. In a few states, you must take an extra step to enroll, but the process is straightforward. Contact your local Social Security office or the Social Security Administration at 1-800-772-1213 to confirm whether you are covered.

Some people with disabilities who do not may have access to for SSI or SSDI may still may have access to for Medicaid based on income and assets alone. The rules for this vary by state. If you have a disability but are not on SSI or SSDI, contact your state Medicaid office to ask whether you meet the income and asset limits.

Medicaid for children and pregnant people

Every state covers children under age 19 with family incomes up to at least 200% of the federal poverty level (about $27,000 per year for a family of three in 2024). Many states cover children with higher incomes. Pregnant people are also covered in all states, usually up to 60 days after the end of pregnancy, regardless of immigration status in some states.

Parents and caretakers of children may also may have access to for Medicaid based on income, depending on the state. In states that expanded Medicaid, parents earning up to 138% of poverty may be covered. In states that did not expand, the income limit for parents is often much lower — sometimes as low as 19% of poverty.

If you are pregnant or have a child, contact your state Medicaid office or visit your state health department website to find out the income limit that applies to you. Many states allow you to explore online or by phone.

How to find out whether you may have access to in your state

The fastest way to learn your state's rules is to visit medicaid.gov, click on your state, and read the "Who is covered" section. This page lists income limits, asset limits (if any), and which groups of people are covered. The information is updated regularly and specific to your state.

You can also call your state Medicaid office directly. The phone number is on your state health department website or on the Medicaid.gov state page. Have your income information and family size ready. Many states also have online tools where you can enter your information and see whether you may be covered.

If you are over 65 or have a disability, you can also contact your local Social Security office at 1-800-772-1213 to ask about both Medicare and Medicaid. Social Security staff can tell you whether you may have access to for Medicare and can refer you to your state Medicaid office if you may be may be able to access for Medicaid as well.

Dual coverage: having both Medicare and Medicaid

If you have Medicare and your income is low enough, you may also may have access to for Medicaid. This is called "dual coverage" or being "dual may be able to access". Medicaid can pay your Medicare premiums, deductibles, and copayments, which saves you money. About 12 million people in the United States have both programs.

To may have access to for Medicaid while on Medicare, your income must be below your state's Medicaid limit. The limit is often higher for people on Medicare than for working-age adults, but it varies by state. If you are on Medicare and think your income is low enough for Medicaid, contact your state Medicaid office and ask about "Medicare Savings Programs" or "Medicaid for Medicare beneficiaries".

Some states have special programs that help Medicare beneficiaries pay premiums and out-of-pocket costs even if they do not quite meet the Medicaid income limit. These are called Medicare Savings Programs (MSP). You can ask your state Medicaid office whether you may have access to for MSP or full Medicaid coverage.

Frequently Asked Questions

Do I have to be a U.S. citizen to get Medicare or Medicaid?

For Medicare, you must be a U.S. citizen or permanent resident (green card holder) with at least 5 years of permanent resident status. For Medicaid, the rules vary by state. Some states cover immigrants regardless of status; others cover only citizens and permanent residents. Contact your state Medicaid office to ask about your immigration status.

What if I worked outside the United States?

If you worked in another country and paid into its social security system, you may still may have access to for Medicare if you also worked in the U.S. for at least 6 quarters (1.5 years) and paid Medicare taxes. Contact Social Security at 1-800-772-1213 to ask about credits from other countries.

Can I get Medicaid if I own a home or have savings?

Medicare has no asset limit. For Medicaid, most states do not count your home as an asset. Some states have a limit on savings and other assets (often $2,000 for a single person), but rules vary. Contact your state Medicaid office to ask about asset limits in your state.

What happens to my Medicaid if my income goes up?

If your income rises above your state's Medicaid limit, you may lose coverage. However, most states have a grace period or allow you to keep coverage for a few months while you report the change. Report income changes to your state Medicaid office right away so you understand how it affects your coverage.

Can I have Medicare and private insurance at the same time?

Yes. Many people have Medicare and a private plan (such as coverage through a spouse's employer). The private plan usually pays second, after Medicare pays its share. Tell your private insurance company that you have Medicare so they coordinate benefits correctly.