Medicaid vs. Medicare: Who Qualifies and Can You Have Both?

Medicare goes by age or disability: it covers people 65 or older, and younger people after 24 months of Social Security disability benefits or with ALS or kidney failure. Medicaid goes by income: it is your state's coverage for people with limited income and savings. You can have both, as 12 million people do: Medicare pays first, and Medicaid covers your Part B premium and much of what Medicare leaves unpaid. If you are 65 or on disability and money is tight, sign up for Medicare through Social Security and apply for Medicaid with your state the same week.

Who gets Medicare

You qualify at 65 if you meet Medicare's citizenship or residency rules. Part A, the hospital coverage, is free if you or your spouse paid Medicare taxes long enough, generally at least 10 years of work. Without that record, Part A costs $311 or $565 a month in 2026.

Under 65, three routes lead to Medicare:

• Social Security disability (SSDI): Medicare starts automatically after you have received disability benefits for 24 months. Your card comes in the mail 3 months before coverage begins.
• ALS: Medicare starts the same month your Social Security disability benefits start.
• Kidney failure (ESRD): you need regular dialysis or a kidney transplant, plus a work record under Social Security, the Railroad Retirement Board or government employment (yours, a spouse's or, for a child, a parent's). On dialysis, coverage usually starts the first day of the fourth month of treatment. Sign up by calling Social Security.

Who gets Medicaid

Medicaid covers children, parents, pregnant women, people 65 and older and people with disabilities who have limited income. Each state sets its own limits under federal rules.

• Adults 19 to 64 in expansion states: in the states that expanded Medicaid, California among them, you qualify on income alone up to 138% of the federal poverty level, roughly $22,000 a year for one person. This adult group ends once you become entitled to Medicare. From January 1, 2027, or earlier if your state chooses, certain adults in this group must also log 80 hours a month of work or other approved activities to get and keep coverage, though a state showing a good-faith effort can get a federal exemption that ends by December 31, 2028.
• States that did not expand: adults under the poverty level with no route through age, disability, pregnancy or children fall into a coverage gap. Apply anyway: every state covers some groups by age, disability and family status.
• SSI recipients: in most states, including California, SSI approval brings Medicaid with it and the SSI application doubles as the Medicaid application. SSI brings Medicaid but not Medicare; Medicare needs one of the routes above.
• People 65 or older or disabled: most states count both income and resources such as bank accounts. Over the income limit, some states let you spend down: medical bills and Medicare premiums you pay are subtracted until your income reaches the Medicaid level.

What Medicaid pays when you also have Medicare

Medicare pays first and Medicaid pays last. With full Medicaid, your state pays your $202.90 monthly Part B premium, you get Extra Help with drug costs automatically, and a Medicare drug plan covers your prescriptions in place of Medicaid. Depending on your Medicaid level, the state also pays Medicare deductibles, coinsurance and copays, plus your Part A premium if you owe one. Medicaid also pays for nursing home care past Medicare's 100-day limit, and states can add optional benefits Medicare leaves out, such as personal care at home and eyeglasses.

Income too high for full Medicaid? The Medicare Savings Programs still pay part or all of your Medicare costs. These are the 2026 limits outside Alaska and Hawaii, and some states approve people above them.

QMB carries the strongest protection: Medicare providers are barred from billing you for deductibles, coinsurance and copays on Medicare-covered care; the only charge allowed is a small Medicaid copay. Show your Medicare card and your Medicaid or QMB card at every visit. QI runs first come, first served, and you reapply every year.

Extra Help lowers Medicare drug costs. It comes automatically with full Medicaid, a Medicare Savings Program or SSI. Everyone else applies through Social Security, with 2026 limits of $23,940 in yearly income and $18,090 in resources for one person ($32,460 and $36,100 for a couple). In 2026 you pay at most $12.65 per covered drug, and in 2027 your plan premium and deductible are $0.

How to apply for each

Medicare. If you get Social Security benefits at least 4 months before you turn 65, you are enrolled in Parts A and B automatically. Everyone else signs up at ssa.gov/medicare/sign-up or by calling 1-800-772-1213 (TTY 1-800-325-0778). Your first window lasts 7 months: the 3 months before your 65th birthday month, that month and the 3 months after. Miss it without job-based coverage and you can go months without coverage and owe a monthly Part B penalty: 10% for each full 12-month period you could have had Part B, for as long as you have Part B. Still working? Read our guide on delaying Medicare first.

Medicaid. Apply with your state Medicaid agency (pick your state on HealthCare.gov's Medicaid page). You can apply any time of year. The same state office handles Medicare Savings Program applications. In California, Medicaid is Medi-Cal: apply at BenefitsCal or with your county office. For Medi-Cal, people 65 or older or disabled can own up to $130,000 in countable assets for one person ($195,000 for two) through June 30, 2027, then $21,000 for one person and $31,000 for two. See Medi-Cal income limits for 2026 and Medicare Savings Programs in California.

Extra Help. Apply at ssa.gov/medicare/part-d-extra-help or by calling 1-800-772-1213. Social Security forwards your information to your state to start a Medicare Savings Program application unless you opt out on the form, so one application opens both.

For free one-on-one Medicare counseling, find your State Health Insurance Assistance Program at shiphelp.org. Medicare answers at 1-800-633-4227, 24 hours a day.

What to do today

1. Pin down your Medicare date. If you turn 65 within 3 months and get no Social Security benefits yet, sign up at ssa.gov/medicare/sign-up.
2. Apply for Medicaid now. File with your state Medicaid agency; filing by December 31, 2026 keeps 3 months of back coverage. Have your Social Security award letter, your Medicare card if you have one, and recent bank statements ready. Ask to be screened for full Medicaid and every Medicare Savings Program.
3. Apply for Extra Help at ssa.gov if you have Medicare and no Medicaid yet.

What to say when you call the Medicaid office

"I [have Medicare / turn 65 on DATE / have received SSDI since MONTH YEAR]. My income is $[amount] a month and my savings are about $[amount]. Please screen me for full Medicaid and for all the Medicare Savings Programs: QMB, SLMB and QI. What proof of income and savings do you need, where do I send it, and when should I expect a decision letter?"

Where it splits

• If you are on expansion Medicaid and Medicare starts: the expansion group ends for anyone entitled to Medicare, and before ending coverage the state must check every other basis of eligibility, such as its programs for people 65 or older or disabled, which count resources too. Return the renewal packet with your bank statements.
• If your income is just over the limit: apply for Extra Help and the Medicare Savings Programs anyway, and ask your state about spend-down.
• If you need a nursing home or help at home: Medicare pays toward up to 100 days of skilled nursing care per benefit period and nothing for long-term custodial care, so apply for Medicaid; see Medicaid home and community-based services for in-home programs.

Your leverage

• A provider bills you while you are in QMB: tell the provider or debt collector you are in QMB and owe nothing for Medicare deductibles, coinsurance or copays beyond a small Medicaid copay. If you already paid, you have a right to a refund through your state Medicaid office. If the bills keep coming, call 1-800-MEDICARE (1-800-633-4227).
• Old medical bills: apply by December 31, 2026, and Medicaid can pay for covered care from the 3 months before the month you apply. For applications filed on or after January 1, 2027, the window is 2 months, or 1 month for adults in the expansion group. List those bills for the caseworker.
• No decision in time: states must decide within 45 days, or 90 for an application based on disability. If no letter comes by then, or you disagree with the decision, ask for a fair hearing.

Call a legal aid office or an elder law attorney before you give away money or property if a nursing home stay is coming: Medicaid reviews transfers made in the 60 months before you apply for nursing home coverage, 30 months in California.

Today

Apply for Medicaid and Extra Help, and sign up for Medicare if you turn 65 within 3 months.

Then the mail starts. An Extra Help notice lists what you will pay and your drug plan, your state sends its Medicaid decision within 45 days (90 for a disability-based application), and once Medicaid or a Medicare Savings Program starts, the state pays your Part B premium.