Medicaid vs Medicare: Eligibility Differences (2026)

Medicare Eligibility Rules in 2026: The Four Pathways

Medicare has four separate eligibility pathways in 2026. You only need to qualify under one.

The age pathway is the most common: turn 65 and you qualify, regardless of income, assets, or health status. You or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters) to receive premium-free Part A. If you haven't, you can buy into Part A for up to $505 per month in 2026.

• Age 65+: Qualify if you or your spouse have 40 work quarters. No income or asset test.
• SSDI disability: Receive Medicare after 24 full months of Social Security Disability Insurance (SSDI) benefits. The clock starts the first month you receive SSDI, not when you applied.
• ALS (Lou Gehrig's Disease): Medicare begins the SAME month SSDI is approved. No waiting period. This exception was established by the ALS Medicare Equity Act, effective 2021.
• ESRD (End-Stage Renal Disease): Medicare begins on the first day of the 4th month of dialysis treatment, or the month of a kidney transplant hospitalization. No age requirement.

Medicaid Eligibility Rules in 2026: Income, Category, and State

Medicaid eligibility requires two things: belonging to a covered category AND meeting income limits. Unlike Medicare, Medicaid has NO national income limit that applies to all adults. The limits depend on both your state and your category.

In the 40 states plus DC that have expanded Medicaid under the ACA, adults aged 19-64 with incomes at or below 138% of the Federal Poverty Level qualify as 'expansion adults.' For 2026, that is roughly $22,025 per year for a single adult. Most MAGI-based Medicaid pathways have NO asset test, meaning savings and home equity are not counted.

• Children: Most states cover children up to 200-350% FPL via Medicaid or CHIP. All 50 states cover children through at least 133% FPL.
• Pregnant women: All 50 states cover pregnancy-related care. Most states set the limit at 138-220% FPL for pregnancy Medicaid.
• Elderly (65+) and people with disabilities: These groups often use non-MAGI Medicaid with an asset test. Income limits are typically set at 100% FPL or SSI level ($967/mo for an individual in 2026). Married couples face a different asset calculation.
• SSI recipients: In most states, receiving Supplemental Security Income (SSI) automatically makes you eligible for Medicaid without a separate application.
• Non-expansion states: In Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming, there is no expansion-adult pathway. Adults without minor children may not qualify at any income level.

2026 Medicaid Income Limits by Household Size (Expansion States)

The table below shows the annual MAGI income limits at 138% FPL for expansion-state adult Medicaid in 2026. These apply in the 40 states and DC that have adopted the ACA expansion. Children's limits and pregnancy limits are often higher.

Dual-Eligible: How to Qualify for Both Medicare and Medicaid

Approximately 12 million Americans are dual-eligible, meaning they qualify for both Medicare and Medicaid at the same time. This is the most comprehensive public health coverage available in the United States.

You can be dual-eligible by meeting Medicare's rules (age 65+, SSDI, ESRD, or ALS) AND meeting your state's Medicaid income limit. The most common path: someone turns 65, qualifies for Medicare, and also has low enough income to qualify for Medicaid. When you are dual-eligible, Medicare pays first and Medicaid wraps around to cover the cost-sharing, premiums, and services Medicare doesn't cover (like long-term care and dental in most states).

Dual-eligible individuals can also enroll in Dual Special Needs Plans (D-SNPs), which are Medicare Advantage plans specifically designed to coordinate both programs under one card.

Key Differences Summarized: What Disqualifies You from Each

For Medicare, the main disqualifiers are: being under 65 without a qualifying disability, ESRD, or ALS diagnosis; not having enough work credits (40 quarters) for premium-free Part A; or not being a qualifying citizen or permanent resident. High income does NOT disqualify you from Medicare, though it triggers an Income-Related Monthly Adjustment Amount (IRMAA) surcharge on Parts B and D premiums.

For Medicaid, the main disqualifiers are: income above your state's limit for your category; living in a non-expansion state without a categorical pathway (i.e., you are a childless adult with no disability); or having assets above the limit in non-MAGI Medicaid programs (applicable to elderly and disabled pathways). Immigration status also matters: undocumented individuals generally do not qualify for full Medicaid, though emergency Medicaid is available.

How to Apply for Medicare vs Medicaid in 2026

Medicare applications go through the Social Security Administration. Low-income Medicare beneficiaries should also check Extra Help eligibility for Part D drug cost assistance. If you are already receiving Social Security retirement benefits or SSDI, you are enrolled in Medicare automatically. If not, apply at SSA.gov or call 1-800-772-1213. Your Initial Enrollment Period is a 7-month window centered on your 65th birthday month.

Medicaid applications go through your state's Medicaid office. You can apply through healthcare.gov (which routes you to your state if you qualify for Medicaid), directly on your state's Medicaid website, or in person at a local benefits office. Medicaid is available year-round, no enrollment period applies.

What is the main difference between Medicare and Medicaid eligibility?

Medicare eligibility in 2026 is based on age (65+), disability via SSDI (24-month wait), ESRD, or ALS. Income and assets are not factors for Medicare. Medicaid eligibility is based on income (typically 138% FPL in expansion states, roughly $22,025/year for a single adult) and belonging to a covered category. Medicaid has no age floor.

Can I get Medicare if I am under 65?

Yes, under three circumstances. If you receive SSDI benefits, you become eligible for Medicare after 24 full months of payments. If you have ALS, Medicare starts the same month your SSDI is approved, with no waiting period. If you have end-stage renal disease (ESRD), Medicare starts the first day of your fourth month of dialysis treatment. These are the only under-65 Medicare pathways.

What income is too high for Medicaid?

In expansion states, adults earning above 138% of the Federal Poverty Level do not qualify for expansion-adult Medicaid. For a single adult in 2026, that cutoff is approximately $22,025 per year (about $1,836/month). In non-expansion states (AL, FL, GA, KS, MS, SC, TN, TX, WI, WY), childless adults are typically ineligible regardless of income. Children and pregnant women often qualify at higher limits.

Does Medicaid have an asset test in 2026?

Most MAGI-based Medicaid pathways (covering expansion adults, children, pregnant women) have NO asset test since 2014 under the ACA. However, elderly and disabled Medicaid pathways, used by people 65+ and those with serious disabilities who need long-term care, still use a traditional means-test that counts assets like savings accounts. Home ownership rules also apply in those non-MAGI pathways.

What does dual-eligible mean?

Dual-eligible means you qualify for both Medicare and Medicaid at the same time. About 12 million Americans are dual-eligible in 2026. To qualify, you must meet Medicare's rules (age 65+, SSDI, ESRD, or ALS) AND your state's Medicaid income limit. When dual-eligible, Medicare pays first and Medicaid wraps around to cover cost-sharing, premiums, and services Medicare doesn't cover, like dental and long-term care.

How does SSDI relate to Medicare eligibility?

Receiving Social Security Disability Insurance (SSDI) makes you eligible for Medicare, but with a 24-month waiting period. The clock starts with the first month you receive SSDI cash benefits, not the application date. After 24 months, Medicare Part A and Part B enrollment is automatic. The one exception is ALS: people with ALS get Medicare the same month SSDI starts, with no wait.

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

Yes. If you meet Medicare's eligibility rules (age, disability, ESRD, or ALS) and also meet your state's Medicaid income limits, you can be dual-eligible and have both simultaneously. Medicare pays first, then Medicaid covers remaining costs. Dual-eligible individuals can also enroll in Dual Special Needs Plans (D-SNPs) to coordinate both programs under one plan.

Does Medicare have income limits?

Medicare has NO income eligibility limit. You qualify based on age, disability, ESRD, or ALS, regardless of income. However, if your income is above certain thresholds, you pay higher Part B and Part D premiums via IRMAA (Income-Related Monthly Adjustment Amount). For 2026, IRMAA applies to individuals with income above $106,000 per year. High income does not eliminate your Medicare benefit.