How Do I Know Which Plan I’m Eligible For?
It’s possible to qualify for Medicare, Medicaid, or both. Here’s a breakdown of the eligibility requirements.
Medicare Eligibility
Medicare is primarily for people ages 65 and older. If you’re younger, you may qualify if you have certain disabilities.
Age-Based Coverage If you are 65 or older and you (or your current or former spouse) paid Medicare taxes for at least 10 years (or 40 quarters), you automatically qualify for premium-free Medicare Part A. If you or your spouse didn’t pay enough Medicare taxes, you can still enroll, but you will pay a premium for Part A.
Disability Coverage If you’re under the age of 65, you may qualify for Medicare through Social Security disability benefits. If you have amyotrophic lateral sclerosis, also called Lou Gehrig’s disease, you can receive Medicare automatically as soon as your Social Security Disability Insurance benefits begin; if you have end-stage renal disease, your benefits begin based in part on when you start receiving treatment. If you have another disability, your coverage starts 24 months after you start getting disability benefits.
Medicaid Eligibility
Medicaid is primarily for people who have limited income and resources. Currently, Medicaid is the single largest source of health coverage in the United States.
Income-Based Coverage You can qualify for Medicaid if your household income is below a certain amount. This amount varies by state (and is based on other factors, such as household size and disability status), but if your state has expanded Medicaid, you qualify if your household income is below 138 percent of the federal poverty level.
For example, a family of four that has an income of $45,540 or less — which, in 2026, is 138 percent of the federal poverty level — would qualify for Medicaid in states that have expanded the program.
Age and Disability Coverage If you’re on Medicare, you may also qualify for Medicaid if your income and assets are low (meaning you have dual eligibility). This can be a good thing, because Medicare doesn’t cover all your health insurance costs.
In most states, you can qualify for Medicaid if you receive Supplemental Security Income, which provides monthly income to people who have disabilities, blindness, or are age 65 or older.
It can be harder to qualify for Medicaid if you’re at least 65 years old, though, because Medicaid takes into account your income and assets when determining eligibility.
Special Circumstances You may also qualify for Medicaid if you were a former foster youth (up to age 26), and you may be able to receive cancer care through Medicaid if you’ve been diagnosed with breast cancer or cervical cancer through federal screening programs.
Medicare Savings Programs
Even if you don’t qualify for Medicaid, you might still be able to get help through a Medicare Savings Program. These programs, run by state Medicaid agencies, help cover Medicare costs like premiums and copays for people with limited income and savings. Again, guidelines differ by state.
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