Medicare and Medicaid are separate federal programs with different rules, funding sources, and who they cover

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). You become may be able to access for it when you turn 65, regardless of income — or earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS. You pay into Medicare through payroll taxes during your working years.

Medicaid is a joint federal and state health insurance program for people with low income. Each state runs its own Medicaid program within federal guidelines, so the income limits, covered services, and rules differ by state. You do not need to be retired or disabled to may have access to for Medicaid — you may have access to based on income and, in some states, other factors like family size or citizenship status.

The confusion happens because both programs cover medical care and both are administered by CMS, but they are funded differently, have different may be able to access rules, and cover different groups of people. You can be on both at the same time — this is called being "dual may be able to access."

Key Takeaways

  • Medicare is a federal program for people 65 and older, or younger people with certain disabilities or conditions, funded through payroll taxes you paid while working.
  • Medicaid is a program for people with low income, run by each state with its own rules, and funded by both federal and state money.
  • Income limits for Medicaid vary by state and change year to year, so you need to check your state's specific rules.
  • You can be on both Medicare and Medicaid at the same time if you meet the requirements for each program.
  • may be able to access for Medicare is the same nationwide, but may be able to access for Medicaid depends on where you live.

How Medicare may be able to access works

You are may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived in the United States for at least five years. You do not have to be retired — you can still be working — and your income does not matter. Medicare Part A (hospital insurance) is free for most people because you paid into it through payroll taxes. Medicare Part B (medical insurance) costs a monthly premium, and Parts C and D (prescription drug coverage and Medicare Advantage plans) have their own costs.

You can also get Medicare before 65 if you have been receiving SSDI for 24 months, if you have end-stage renal disease, or if you have been diagnosed with ALS (amyotrophic lateral sclerosis). In these cases, age does not matter — the condition itself makes you may be able to access.

You enroll in Medicare during your Initial Enrollment Period, which is the three months before the month you turn 65, the month you turn 65, and the three months after. If you miss this window, you pay a permanent penalty on your premiums, so timing matters. You can enroll through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

How Medicaid may be able to access works

Medicaid may be able to access is based on income, and the income limit varies by state. In most states, a single adult can earn up to around 130 to 150 percent of the federal poverty line and still may have access to, but some states have higher or lower limits. A few states have not expanded Medicaid at all, so the income limits are much lower. You have to check your state's specific rules — there is no single nationwide number.

Some states also consider other factors beyond income: whether you are pregnant, disabled, a child, a parent, or elderly. Some states count assets (savings, property) and some do not. Some states require you to be a U.S. citizen or permanent resident, and some have different rules for immigrants. Because the rules change by state and sometimes change within a state from year to year, the only way to know if you may have access to is to contact your state Medicaid office or use the federal Health Insurance Marketplace at Healthcare.gov.

You can explore for Medicaid any time of year — there is no enrollment period like Medicare has. Once you are approved, coverage usually starts on the first day of the month you applied or the month after, depending on your state.

What each program covers

Medicare covers hospital stays (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D). It also covers some preventive services like cancer screenings and flu shots at no cost to you. Medicare does not cover dental, vision, or hearing aids in most cases — you have to buy separate coverage for those, or choose a Medicare Advantage plan (Part C) that may include them.

Medicaid covers doctor visits, hospital stays, emergency care, and prescription drugs. It also covers some services Medicare does not, like dental care, vision care, and long-term care (nursing home or home health services). What Medicaid covers depends on your state — some states cover more services than others. For example, some states cover dental care for adults and some do not.

If you are on both Medicare and Medicaid, Medicare is your primary insurance and pays first. Medicaid then covers what Medicare does not pay, including copays and deductibles. This is why dual-may be able to access people often have lower out-of-pocket costs.

Income limits and how they affect you

Medicare has no income limit — you can earn any amount and still may have access to at 65. Your income does not affect whether you get Medicare or how much you pay for Part A (hospital insurance), though it does affect your Part B and Part D premiums if your income is very high (over $97,000 for a single person in 2024, though this threshold changes yearly).

Medicaid income limits are set by each state and are usually expressed as a percentage of the federal poverty line. The federal poverty line for 2024 is about $14,600 for a single adult, but states can set their own limits higher or lower. Some states expanded Medicaid to cover people earning up to 138 percent of the poverty line (about $20,100 for a single adult), and some states have not expanded and keep the limit much lower. You need to check your state's current limit — it may have changed since last year.

When you might may have access to for both programs

You can be on both Medicare and Medicaid if you meet the requirements for each. This usually happens if you are 65 or older with low income, or if you are under 65, disabled, and have low income. People who are dual-may be able to access often have the lowest out-of-pocket costs because Medicaid covers Medicare's copays, coinsurance, and deductibles.

If you are on SSDI (Social Security Disability Insurance) and your income is low enough, you may may have access to for Medicaid while you wait to turn 65 and become may be able to access for Medicare automatically. Once you turn 65, you move from SSDI to Social Security retirement benefits, but your Medicare coverage continues. If your income stays low, your Medicaid coverage may continue too.

How to find out which program you might be on

If you are 65 or older, you are may be able to access for Medicare. You do not have to do anything if you are already receiving Social Security — Medicare is enrolled automatically three months before your 65th birthday. If you are not receiving Social Security yet, you need to enroll during your Initial Enrollment Period or pay a penalty.

To learn about you may have access to for Medicaid, contact your state Medicaid office or use the federal Health Insurance Marketplace at Healthcare.gov. You can also call 211 (a free referral service) and ask for your state Medicaid office. Have your income information and household size ready. Some states process applications in a few days and some take several weeks.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older with low income, or if you are disabled with low income, you may may have access to for both. Medicaid then pays your Medicare copays and deductibles, which lowers your out-of-pocket costs. Contact your state Medicaid office to learn about you may have access to.

What is the income limit for Medicaid where I live?

It depends on your state. Most states cover people earning up to 130 to 150 percent of the federal poverty line, but some states have higher or lower limits. Check your state Medicaid office website or call Healthcare.gov at 1-800-318-2596 to find your state's current limit.

Do I have to pay for Medicare?

Medicare Part A (hospital insurance) is free for most people 65 and older because you paid into it through payroll taxes. Part B (doctor visits) costs a monthly premium, usually around $165 to $560 depending on your income. Part D (prescription drugs) also has a monthly cost that varies by plan.

What happens to my Medicaid when I turn 65 and become may be able to access for Medicare?

You become may be able to access for Medicare automatically at 65, but your Medicaid coverage does not stop unless your income goes above your state's limit. If you stay on Medicaid, it becomes your secondary insurance and covers Medicare's copays and deductibles. Contact your state Medicaid office to confirm your coverage continues.

Can I switch from Medicaid to Medicare before I turn 65?

No. You cannot switch to Medicare before 65 unless you have been on SSDI for 24 months, have end-stage renal disease, or have ALS. If you have one of these conditions, you become may be able to access for Medicare regardless of age. Otherwise, you stay on Medicaid until you turn 65.