How to Qualify for Medicare or Medicaid

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While some people assume that Medicare and Medicaid are the same program, they are actually very different. Medicare is federally funded health insurance for people over age 65, disabled or who have end-stage renal disease. Medicaid, on the other hand, refers to health care coverage for low-income Americans and is administered by individual states. Medicaid recipients must fall within the low-income guidelines established by the federal government or have certain qualifying family members. In some cases, low-income senior citizens qualify for both Medicare and Medicaid.

Qualifying for Medicare

After turning 65, most Americans automatically qualify for Medicare if they worked for at least 10 years in Medicare-eligible employment.

Collect Social Security or Railroad Retirement Board disability benefits for at least 24 months. If you receive these benefits, you may be eligible for Medicare even if you are not age 65.

Qualify for Medicare with a diagnosis of end-stage renal disease, which is any kidney condition that requires a kidney transplant or dialysis. You can receive Medicare benefits at any age if you have this condition.

Qualifying for Medicaid

Meet the residency requirements for your state. In most states, you must be a U.S. citizen or legal immigrant and a resident of the state to qualify.

Satisfy the income requirements for the appropriate Medicaid program. Depending on your household size and makeup, you may qualify for Medicaid if your household income is equal to or less than 100 to 200 percent of the federal poverty guidelines. Your income requirements vary depending on whether there are infants, children or disabled persons living in your household.

Meet the asset guidelines if required by your state. Some states take your assets, such as property, bank accounts, stocks and retirement plans into account when determining your eligibility for Medicaid.


  • Some states offer low-cost health insurance programs for children in families that do not qualify for Medicaid. Your state children’s health insurance program office can provide additional information about available programs

    Medically needy families that cannot afford health insurance and do not qualify for Medicaid can either pay a monthly premium for their Medicaid coverage or have the cost of medical care deducted from their income. They may qualify for Medicaid coverage when the remaining income falls below federal poverty limits for their household size.


About the Author

An adjunct instructor at Central Maine Community College, Kristen Hamlin is also a freelance writer on topics including lifestyle, education, and business. She is the author of Graduate! Everything You Need to Succeed After College (Capital Books), and her work has appeared in Lewiston Auburn Magazine, Young Money, USA Today and a variety of online outlets. She has a B.A. in Communication from Stonehill College, and a Master of Liberal Studies in Creative Writing from the University of Denver.

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