How to Apply for Medicare and Medicaid: A Step-by-Step Guide

Understanding how to apply for Medicare and Medicaid can mean the difference between paying thousands in medical bills and paying nothing at all.

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Millions of eligible Americans miss out on healthcare coverage simply because they do not know where to start or how each program works.

This guide explains the difference between both programs, who qualifies, and exactly how to enroll in 2026.

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Medicare vs. Medicaid: What’s the Difference?

Medicare and Medicaid are both federally backed health insurance programs, but they serve different populations and function in fundamentally different ways. Confusing the two is extremely common — and can cause eligible people to apply to the wrong program or miss coverage they are entitled to.

Feature	Medicare	Medicaid
Primary audience	Adults 65+ and certain disabled individuals	Low-income individuals and families of all ages
Federal vs. state role	Fully federal program	Federal-state partnership; varies by state
Income requirement	None (age or disability-based)	Required; based on household income and size
Work history required	Yes (for premium-free Part A)	No
Premiums	Part A often free; Part B has monthly premium	Typically $0 or very low cost shares
Application site	SSA.gov or Medicare.gov	State Medicaid agency or Healthcare.gov

The important thing to know is that these programs can overlap. Individuals who qualify for both are called “dual eligibles” or Medicare-Medicaid enrollees. Medicaid in this case acts as secondary insurance, covering costs that Medicare does not — including copays, deductibles, and benefits like dental and vision that traditional Medicare excludes.

Who Qualifies for Medicare

Medicare is primarily an age-based and disability-based federal health insurance program. Here is who qualifies:

Age 65 or older: U.S. citizens and legal permanent residents who have lived in the country for at least five years continuously are eligible for Medicare at age 65, regardless of income.
Under 65 with a qualifying disability: Individuals who have received Social Security Disability Insurance (SSDI) for at least 24 months automatically become eligible for Medicare, regardless of age.
End-Stage Renal Disease (ESRD): Individuals of any age with permanent kidney failure requiring dialysis or a transplant qualify for Medicare.
ALS (Amyotrophic Lateral Sclerosis): Individuals diagnosed with ALS qualify for Medicare immediately upon receiving SSDI, without the standard 24-month waiting period.

Medicare Parts explained:

Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. Premium-free for most people who worked and paid Medicare taxes for 10+ years (40 quarters).
Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical equipment. Standard monthly premium in 2025 is $185 (subject to income-based adjustments).
Part C (Medicare Advantage): Private insurance plans approved by Medicare that bundle Parts A, B, and often D with additional benefits (dental, vision, gym memberships). Offered through private insurers.
Part D (Prescription Drug Coverage): Adds prescription drug coverage, offered through private plans. Monthly premiums vary by plan.

⚡ Enrollment Window: Your initial Medicare enrollment window opens 3 months before your 65th birthday and closes 3 months after. Enrolling late can result in permanent late enrollment penalties on your Part B premium. Set a reminder well in advance.

Who Qualifies for Medicaid: Income Limits Explained

Medicaid is a needs-based health insurance program for individuals and families with limited income. Since the Affordable Care Act (ACA), most states that have adopted Medicaid expansion offer coverage to adults with incomes up to 138% of the Federal Poverty Level (FPL) — regardless of whether they have children.

Medicaid income eligibility by household size (138% FPL, 2024 guidelines — expansion states):

Household Size	Annual Income Limit (approx.)	Monthly Income Limit (approx.)
1 person	$20,120	$1,677
2 people	$27,214	$2,268
3 people	$34,307	$2,859
4 people	$41,400	$3,450
5 people	$48,493	$4,041

As of 2026, 40 states plus Washington D.C. have adopted the Medicaid expansion. In the 10 states that have not expanded, Medicaid eligibility is often much more restrictive and may require children, pregnancy, or a disability in the household.

Medicaid eligibility always includes children and pregnant women at broader thresholds than the standard adult expansion guidelines, and CHIP (Children’s Health Insurance Program) fills gaps for children in households slightly above Medicaid income limits.

What Medicare and Medicaid Cover

Coverage details are one of the most important factors when evaluating which program suits your situation. Here is a clear overview:

Medicare covers:

Inpatient hospital care (Part A)
Doctor visits and outpatient procedures (Part B)
Preventive services: flu shots, cancer screenings, annual wellness visits (Part B)
Ambulance services and medical equipment
Prescription drugs (Part D)
Hospice care and limited home health services (Part A)
Some dental, vision, and hearing services through Medicare Advantage (Part C) plans

Standard Medicare does NOT cover: Most routine dental, vision, hearing aids, long-term custodial care, or most care outside the United States.

Medicaid covers (varies by state):

Doctor visits, hospital care, and emergency services — typically with $0 copays or very minimal cost sharing
Dental, vision, and hearing services (more comprehensive than Medicare in most states)
Mental health and substance use disorder treatment
Prescription drugs
Long-term care services and nursing home coverage (a major advantage over Medicare)
Transportation to medical appointments in many states

💡 Dual Eligible Advantage: If you qualify for both Medicare and Medicaid (dual eligibility), Medicaid typically covers your Medicare Part B premium, copays, and deductibles — reducing your total out-of-pocket healthcare cost to near zero. This represents a significant financial benefit for low-income seniors and disabled individuals. See our guide on all government benefits available to low-income households for related programs.

How to Enroll in Medicare and Medicaid Online: Step by Step

Applying for Medicare:

Visit ssa.gov or medicare.gov to start your Medicare application online. You can also apply by calling Social Security at 1-800-772-1213 or visiting your local Social Security office.
Create or log in to your my Social Security account at ssa.gov/myaccount. This account is used to manage your Medicare enrollment and view your benefits history.
Complete the Medicare Part A and Part B enrollment form (CMS-40B for Part B if enrolling separately). If you are already receiving Social Security retirement or disability benefits, you are typically enrolled in Medicare automatically at age 65.
If you want Part D (drug coverage), you must separately enroll in a Part D plan through Medicare.gov’s plan finder tool. Compare plans by your specific medications, premiums, and pharmacy network.
If you are interested in Medicare Advantage (Part C), use the Medicare Plan Finder at medicare.gov to compare available plans in your ZIP code.

Applying for Medicaid:

Visit healthcare.gov or your state’s Medicaid agency website. In states using the federal exchange, applying through Healthcare.gov automatically screens you for both Medicaid and Marketplace insurance plans.
Provide basic household and income information. The application is free and typically takes 15–30 minutes to complete online.
Upload or mail required verification documents (proof of identity, residency, income, and citizenship or immigration status).
Receive your eligibility determination. Most states process Medicaid applications within 45 days. Some states offer near-immediate determinations for clearly eligible applicants.
Receive your Medicaid card and select a managed care plan if your state uses managed Medicaid (most do). Your coverage begins on the effective date noted on your approval letter.

Frequently Asked Questions About Medicare and Medicaid

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

Yes. Approximately 12 million Americans are enrolled in both programs simultaneously — these are called “dual eligible” beneficiaries. If you are 65+ or disabled (qualifying for Medicare) and also have low income (qualifying for Medicaid), you may receive both coverages at the same time. Medicaid typically acts as secondary insurance, covering Medicare’s cost-sharing requirements and filling coverage gaps.

Is Medicaid free?

For most low-income enrollees, Medicaid has little to no cost. There are no premiums for most Medicaid recipients, and copays for services are typically $0 to $4. Some states charge small monthly premiums for household incomes slightly above the poverty line, but even these are far below the cost of commercial health insurance. Long-term care Medicaid may involve spend-down rules for individuals with assets above certain thresholds.

When should I sign up for Medicare?

You should enroll in Medicare during your Initial Enrollment Period (IEP), which begins 3 months before the month you turn 65 and ends 3 months after. If you miss this window and are not covered by employer-sponsored insurance, you will face a permanent late enrollment penalty added to your Part B monthly premium. If you are still covered by a qualifying employer plan, you may delay Part B enrollment without penalty until that coverage ends.

Does my immigration status affect Medicare or Medicaid eligibility?

For Medicare, you must be a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least 5 consecutive years. For Medicaid, eligibility for non-citizens varies by state and immigration status category. Qualified aliens — including lawful permanent residents — may be eligible for Medicaid with a 5-year bar in some states. Refugees, asylees, and certain other categories may be eligible immediately. Undocumented individuals are generally ineligible for full Medicaid benefits but may receive emergency Medicaid in most states.

What if I am denied Medicaid?

If your Medicaid application is denied, you have the right to appeal the decision. Your denial notice will include instructions and deadlines for filing an appeal. You may request a fair hearing through your state’s Medicaid agency. If your income is above Medicaid limits but below 400% of the Federal Poverty Level, you may qualify for a subsidized health insurance plan through the Marketplace at healthcare.gov, often with significant premium tax credits. See also our guide on applying for all available government assistance.

⚠️ Editorial Notice: This content is independent and has no affiliation with the Centers for Medicare & Medicaid Services (CMS), the Social Security Administration, or any state Medicaid agency. Program rules, income thresholds, premiums, and coverage details change annually. Always verify current information directly at medicare.gov, medicaid.gov, or healthcare.gov before making any enrollment decision.

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