Medicare covers people 65 and older, people with certain disabilities, and people with permanent kidney failure. Medicaid covers low-income Americans across several categories, including children, pregnant women, seniors, and people with disabilities. Together, these two programs provide health coverage to well over 140 million people in the United States. Some people qualify for both at the same time.
Who Qualifies for Medicare
Medicare is a federal health insurance program, and eligibility is based primarily on age, disability, or specific medical conditions rather than income. There are three main pathways in.
Age 65 and older: If you’ve worked and paid Medicare taxes for at least 10 years (40 quarters), you automatically qualify for premium-free Medicare Part A when you turn 65. About 99% of Medicare beneficiaries meet this threshold. If you have fewer than 40 quarters of work history, you can still enroll in Part A by paying a monthly premium. People with at least 30 quarters of covered employment pay a reduced premium of $311 per month in 2026.
Disability: People under 65 who receive Social Security Disability Insurance (SSDI) become eligible for Medicare after a 24-month waiting period from when their disability benefits begin. One major exception: people diagnosed with ALS (Lou Gehrig’s disease) get Medicare coverage as soon as their disability benefits start, with no waiting period.
End-stage renal disease (ESRD): If your kidneys have permanently failed and you need regular dialysis or a kidney transplant, you can qualify for Medicare at any age. You or your spouse must have enough work history under Social Security, or you must already be receiving Social Security or Railroad Retirement benefits. Coverage typically starts in the fourth month of dialysis, though it can begin earlier if you train for home dialysis or are admitted for a kidney transplant.
Who Qualifies for Medicaid
Medicaid is a joint federal and state program, and eligibility rules vary by state. As of November 2025, roughly 68.8 million people were enrolled in Medicaid, with another 7.2 million enrolled in the related Children’s Health Insurance Program (CHIP). Unlike Medicare, Medicaid is fundamentally income-based, but you also need to fall into a covered category.
The groups that every state must cover include low-income families with children, pregnant women, children up to at least 133% of the federal poverty level, and people receiving Supplemental Security Income (SSI) due to age, blindness, or disability. Most states cover children at income levels even higher than 133% of FPL.
Medicaid Expansion States
Under the Affordable Care Act, states were given the option to expand Medicaid to all adults aged 18 to 64 with household incomes up to 138% of the federal poverty level, regardless of family status or health conditions. In states that adopted this expansion, you can qualify based on income alone. You don’t need to be a parent, pregnant, or disabled. In states that did not expand Medicaid, many low-income adults without children still fall into a coverage gap where they earn too much for traditional Medicaid but too little for marketplace subsidies.
Seniors and People With Disabilities
For people 65 and older or those with blindness or a disability, Medicaid eligibility is generally determined using the same income rules as the SSI program. These groups are also subject to asset limits, not just income thresholds. For many Medicaid categories serving seniors, countable resources cannot exceed $9,950 for an individual or $14,910 for a married couple in 2026. Your home, one vehicle, and certain other assets are typically excluded from this count.
Non-Citizens
Qualified immigrants, such as green card holders, are generally subject to a five-year waiting period before they can enroll in Medicaid. Several groups are exempt from this waiting period, including refugees, asylees, Cuban and Haitian entrants, trafficking victims, and families of veterans. States also have the option to cover lawfully residing children and pregnant women without imposing the five-year bar.
People Who Qualify for Both Programs
About 13.1 million people, roughly 1 in 5 Medicare beneficiaries, are “dual eligible,” meaning they have both Medicare and Medicaid coverage. This most commonly applies to low-income seniors and younger adults with disabilities who meet Medicare’s age or disability requirements and also have income and assets low enough to qualify for Medicaid.
For dual-eligible individuals, Medicare serves as the primary insurance, covering hospital stays, doctor visits, and prescription drugs. Medicaid then fills in gaps that Medicare doesn’t cover, including long-term care services, dental care, and vision care. Medicaid may also pay Medicare premiums and cost-sharing expenses, reducing out-of-pocket costs significantly.
Medicare Savings Programs for Low-Income Beneficiaries
Even if you don’t fully qualify for Medicaid, you may be eligible for a Medicare Savings Program that helps cover your Medicare costs. These programs are administered through your state Medicaid office.
- Qualified Medicare Beneficiary (QMB): Covers your Part A and Part B premiums, deductibles, and copayments. In 2026, the income limit is $1,350 per month for individuals or $1,824 for married couples, with assets under $9,950 (individual) or $14,910 (couple).
- Specified Low-Income Medicare Beneficiary (SLMB): Covers your Part B premium. The income limit is $1,616 per month for individuals or $2,184 for couples, with the same asset limits as QMB.
People enrolled only in these savings programs are considered “partial-benefit” dual eligibles. They receive help with Medicare costs but don’t get the full range of Medicaid benefits like long-term care or dental coverage.
Key Differences at a Glance
The simplest way to think about these two programs: Medicare is primarily about age and work history, while Medicaid is primarily about income and financial need. Medicare doesn’t care how much money you make. Medicaid doesn’t care how long you’ve worked, though it does look at what category you fall into. When someone meets both sets of criteria, they can receive both forms of coverage simultaneously, with each program covering what the other does not.