Medicaid and Medicare for People Under 65: What's the Real Difference

How Medicaid and Medicare differ, and why it matters under 65

Medicaid and Medicare are separate programs run by different parts of the government, and they cover different groups of people. If you are under 65 and have a disability, you may be on Medicaid, Medicare, or both — and which one you are on changes what doctors you can see, what prescriptions cost, and whether you pay anything at the doctor's office.

Medicaid is a joint federal and state program that covers people with low income, including many people with disabilities under 65. Your state runs it, your income and assets matter, and there is no monthly premium for most people. Medicare is a federal program for people 65 and older, but people under 65 with certain disabilities or end-stage renal disease can get it too. You pay a monthly premium, and it does not check your income or assets.

The practical difference: Medicaid often covers more services (like long-term care or therapy) but has stricter rules about which doctors you can use. Medicare covers hospital and doctor visits broadly but has higher out-of-pocket costs and covers fewer support services. Many people under 65 with disabilities are on Medicaid alone. Some are on both programs at once — this is called "dual may be able to access" — and the rules get more complicated.

Key Takeaways

• Medicaid is for people with low income and is run by your state; Medicare is federal and does not check income, but is usually for people 65 and older unless you have a may have access to disability.
• If you are under 65 with a disability, you likely may have access to for Medicaid in your state, and you may also may have access to for Medicare if your disability is on the Social Security Administration's list.
• Medicaid often covers more services like therapy and long-term care, while Medicare covers hospital and doctor visits but with higher out-of-pocket costs.
• If you are on both programs, Medicaid is your primary payer for most services, and the coordination between them can be confusing — your state Medicaid office can explain how it works in your case.

Who qualifies for Medicaid under 65

Medicaid covers people under 65 with disabilities in every state, but the income and asset limits vary by state. Generally, if you receive Supplemental Security Income (SSI) from Social Security, you automatically may have access to for Medicaid in most states. If you receive Social Security Disability Insurance (SSDI) but not SSI, you may still may have access to depending on your income and your state's rules.

Each state sets its own income limit — some states use the federal SSI limit (around $943 per month for an individual in 2024, though this changes yearly), and others use higher limits. Some states also let you keep more assets than the federal limit allows. The only way to know your state's exact rules is to contact your state Medicaid office or call 211 and ask for a Medicaid specialist in your area.

If you do not receive SSI or SSDI, you can still apply for Medicaid based on disability and income. You will need to show that you have a condition that meets Social Security's definition of disability and that your income and assets fall within your state's limits. The application process is the same whether you apply through your state Medicaid office, online, or by mail.

Who qualifies for Medicare under 65

Medicare for people under 65 requires a specific may have access to condition. You can get Medicare if you have received SSDI benefits for 24 months, if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or if you have amyotrophic lateral sclerosis (ALS). These are the only three routes to Medicare before age 65.

The 24-month waiting period for SSDI recipients starts from the month Social Security approves your claim, not from the month you apply. So if you were approved in January, you become Medicare-may be able to access in January of the second year after approval. Social Security will contact you automatically when you become may be able to access — you do not have to do anything.

If you have end-stage renal disease or ALS, you can get Medicare immediately without waiting. You will need to provide medical documentation to Social Security, and they will enroll you. Unlike Medicaid, Medicare does not check your income or assets, so you can have a job and still may have access to.

What each program covers and what it costs

Medicaid covers a broad range of services that Medicare does not. These include long-term care (nursing homes and assisted living), personal care assistance, therapy services, dental care, vision care, and transportation to medical appointments. Medicaid also covers prescriptions, usually with a small copay or no copay at all. Most people on Medicaid pay nothing at the doctor's office.

Medicare covers hospital stays (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D) if you enroll. But Medicare has higher out-of-pocket costs: you pay a deductible before Medicare starts paying, you pay coinsurance for hospital stays, and you pay 20 percent of the cost of doctor visits after the deductible. Prescription drug coverage through Part D has a coverage gap where you pay more out of pocket.

If you are on both Medicaid and Medicare (dual may be able to access), Medicaid usually pays your Medicare premiums and cost-sharing, and it covers services Medicare does not. This makes dual coverage valuable if you may have access to, because you get the broad service coverage of Medicaid plus the hospital and doctor coverage of Medicare.

How to find out which program you are on

If you receive SSI, you are on Medicaid. If you receive SSDI and have been receiving it for 24 months, you are on Medicare. If you receive both SSI and SSDI (which is rare but possible), you are on both. You can check your Social Security account online at ssa.gov, or call Social Security at 1-800-772-1213 to ask which benefits you are receiving.

Your Medicaid card will say "Medicaid" and your state's name. Your Medicare card will say "Medicare" and have a red, white, and blue design. If you have both, you will have both cards. If you are unsure whether you have Medicaid, call your state Medicaid office — the number is on any medical bill you have received, or you can find it by searching "[your state] Medicaid" online.

If you are on Medicare and want to know whether you also may have access to for Medicaid, contact your state Medicaid office. They will ask about your income and assets and tell you whether you may have access to. Some people on Medicare do not realize they also may have access to for Medicaid until they apply.

What happens if you work or your income changes

If you are on Medicaid and your income increases because you start working, you may lose Medicaid coverage. However, most states have work incentive programs that let you keep Medicaid for a period of time even if your income goes over the limit. These programs have names like "Medicaid Buy-In" or "Work Incentive Program," and they vary by state. Contact your state Medicaid office to ask what work incentives are available to you.

If you are on Medicare, working does not affect your coverage — Medicare does not check income. However, if you work and earn over a certain amount, Social Security may reduce your SSDI benefit. This is called the "substantial gainful activity" limit, and it changes yearly. Social Security can tell you the current limit and how it applies to your situation.

If your income decreases, you should report it to both Medicaid and Social Security. For Medicaid, contact your state office. For Social Security, you can report changes online, by phone, or in person at your local Social Security office. Reporting changes quickly helps you avoid overpayments or loss of benefits you are may have access to to.

Switching between programs or adding coverage

You cannot switch from Medicaid to Medicare on your own — Medicare may be able to access is determined by Social Security based on your disability status and how long you have been receiving SSDI. If you become Medicare-may be able to access, Social Security will enroll you automatically.

If you are on Medicare and want to add Medicaid, you apply through your state Medicaid office. If you are on Medicaid and become Medicare-may be able to access, you stay on Medicaid and Medicare starts automatically — you do not lose Medicaid. In fact, being on both is common and usually beneficial because Medicaid covers services Medicare does not.

If you are on Medicaid and your state has a Medicaid managed care plan (most states do), you may be assigned to a plan or given a choice of plans. The plan coordinates your care and may limit which doctors you can see. If you do not like your assigned plan, you can usually request a different one. Ask your state Medicaid office about your options.

Frequently Asked Questions

Can I have both Medicaid and Medicare at the same time?

Yes. If you are on Medicaid and become Medicare-may be able to access (usually after 24 months on SSDI), you will have both. Medicaid will pay your Medicare premiums and help with out-of-pocket costs, and it will cover services Medicare does not, like long-term care and therapy. This is called dual may be able to access status.

If I am on Medicaid and get a job, will I lose coverage?

Not immediately. Most states have work incentive programs that let you keep Medicaid for a period of time even if your income exceeds the limit. The length of time and the income threshold vary by state. Contact your state Medicaid office to ask what work incentives apply to you before you start working.

Does Medicare cover therapy or long-term care?

Medicare covers some therapy (physical therapy, occupational therapy, speech therapy) if it is ordered by a doctor and deemed medically necessary, but only for a limited time. It does not cover long-term care like nursing homes or assisted living. Medicaid covers both long-term care and ongoing therapy services.

What if I disagree with a Medicaid or Medicare decision about my coverage?

Both programs have appeal processes. For Medicaid, contact your state Medicaid office and ask how to file an appeal. For Medicare, you can appeal a coverage denial or payment decision by contacting Medicare at 1-800-MEDICARE. You have a time limit to appeal, so act quickly if you disagree with a decision.

How do I know if my doctor accepts Medicaid or Medicare?

Call your doctor's office and ask. You can also search your state Medicaid website for a provider directory, or call your Medicaid plan if you are in a managed care plan. For Medicare, you can search Medicare.gov for providers who accept Medicare. If your doctor does not accept your insurance, ask for a referral to someone who does.