Medicare and Medicaid are two separate government health insurance programs with different eligibility rules. Medicare is primarily based on age or disability, while Medicaid is based on income. Some people qualify for both at the same time.
Medicare Eligibility: Age, Disability, or Kidney Failure
Medicare covers three main groups of people: those 65 and older, certain people under 65 with disabilities, and people with permanent kidney failure requiring dialysis or a transplant.
If you’re 65 or older and have earned enough work credits through payroll taxes (generally about 10 years of work), you qualify for premium-free Medicare Part A, which covers hospital stays. You don’t need to be retired to enroll. Your spouse can also qualify based on your work record, even if they never worked themselves. If you haven’t earned enough credits, you can still buy into Part A, though you’ll pay a monthly premium, and waiting past your initial enrollment window can increase that premium by up to 10% for a penalty period.
Part B, which covers doctor visits and outpatient care, requires a monthly premium regardless of your work history. Most people pay a standard amount that’s deducted from their Social Security check.
Medicare Before Age 65
If you’re under 65 and receive Social Security Disability Insurance (SSDI), you become eligible for Medicare after a 24-month waiting period from the date your disability benefits begin. That’s two full years of receiving SSDI checks before Medicare coverage kicks in, a gap that leaves many disabled people without affordable insurance during a period of high medical need.
There are two notable exceptions. People with end-stage renal disease (permanent kidney failure) can get Medicare without waiting 24 months. And people diagnosed with ALS (Lou Gehrig’s disease) receive Medicare as soon as their SSDI benefits start, with no waiting period at all.
Who Qualifies for Medicaid
Medicaid is a joint federal and state program, so eligibility rules vary depending on where you live. The biggest factor is your income, measured as a percentage of the Federal Poverty Level (FPL). But your age, whether you have children, and whether your state expanded Medicaid under the Affordable Care Act all play a role too.
In the 40 states (plus Washington, D.C.) that expanded Medicaid, most adults with incomes up to 138% of the FPL qualify. As of January 2025, that threshold applies to both parents and adults without children. For a single person, 138% FPL translates to roughly $20,800 per year. You don’t need to have kids or a disability to qualify in expansion states.
In states that did not expand Medicaid, the picture is much more restrictive. Adults without children often have no pathway to Medicaid at all unless they are pregnant, disabled, or elderly. Parents may qualify, but at much lower income limits. Georgia, for example, covers some adults up to 100% FPL only if they meet a work requirement. Wisconsin covers adults up to 100% FPL but through its own program rather than the ACA expansion. In several non-expansion states, a working parent earning just a few hundred dollars a month can earn too much for Medicaid yet too little for marketplace subsidies.
Asset Limits for Older Adults and People With Disabilities
For most working-age adults, Medicaid eligibility is based purely on income. But if you’re 65 or older, blind, or disabled and applying through a non-income-based pathway, states typically count your assets too. The most common threshold is $2,000 in countable assets for an individual and $3,000 for a couple. Countable assets include bank accounts, stocks, and other financial resources, but generally not your primary home or one vehicle.
These limits date back to the Supplemental Security Income (SSI) program, which caps income at $943 per month and assets at $2,000 for individuals. If you receive SSI, you automatically qualify for Medicaid in most states. A handful of states have eliminated asset limits entirely. California, Arizona, Hawaii, Illinois, Kansas, Minnesota, North Dakota, and Wisconsin reported having no asset limits for at least some Medicaid pathways.
Citizenship and Residency Requirements
Both Medicare and Medicaid require applicants to be U.S. citizens, U.S. nationals, or have a qualifying immigration status. For Medicaid, lawful permanent residents (green card holders) are generally subject to a five-year waiting period before they can enroll, though states can choose to cover certain groups sooner, particularly pregnant women and children. Individuals without satisfactory immigration status can only receive limited services, such as emergency Medicaid.
You must also be a resident of the state where you’re applying for Medicaid. There’s no minimum time you need to have lived there, but you do need to intend to stay.
Qualifying for Both Programs at Once
About 12 million Americans are “dual eligible,” meaning they’re enrolled in both Medicare and Medicaid simultaneously. This typically happens when someone qualifies for Medicare through age or disability and also has income low enough to meet their state’s Medicaid thresholds.
Being dual eligible is a significant financial benefit. Medicaid can cover costs that Medicare doesn’t, including long-term nursing home care, dental and vision services, and Medicare premiums, deductibles, and copays. For people living on SSI or a small Social Security check, this combination eliminates most out-of-pocket health care costs.
To qualify for both, you simply need to meet each program’s requirements independently. There’s no separate “dual eligible” application. You enroll in Medicare through Social Security and apply for Medicaid through your state’s Medicaid office. If you qualify for both, the two programs coordinate your coverage automatically.
How to Check Your Eligibility
For Medicare, your initial enrollment period begins three months before the month you turn 65 and ends three months after. If you’re already receiving Social Security benefits, you’ll be enrolled automatically. If you’re under 65 and on SSDI, mark your calendar for 24 months after your benefits started.
For Medicaid, you can apply any time of year through your state’s Medicaid agency or through HealthCare.gov. There’s no open enrollment period. Eligibility is determined based on your current monthly income, household size, and state of residence. If your income changes or you move to a new state, your eligibility may change too, since each state sets its own rules within federal guidelines.