Medicaid After 65: What It Is, What It Covers and Who May Qualify

ByWalt Pearson

Medicare and Medicaid sound alike, and people mix them up all the time. They are two different programs, and knowing the difference can matter a great deal later in life. This guide explains Medicaid in plain English: what it is, what it can help with, who may qualify, and how to find out about your own situation.

Rules change, and every state runs its own program. The details below come from Medicare.gov, Medicaid.gov and AARP, and the figures are as of October 2026 unless noted. Your state Medicaid office has the final word on your case.

What Medicaid Is

Medicaid is a health coverage program for people with limited income and resources. The federal government and each state run it together. Within federal rules, each state designs its own version, so the name, the benefits and the rules differ from place to place. Tennessee calls its program TennCare, California calls it Medi-Cal, and Oklahoma calls it SoonerCare.

As Medicare.gov puts it, the rules about who is eligible for Medicaid are different in each state. That is the most important thing to remember.

How Medicaid Differs From Medicare

Medicare is the federal health insurance program most people join at 65. It does not depend on your income. Medicaid does depend on income and resources.

The two can work together. People who have Medicare and full Medicaid benefits are called “dually eligible.” For them, Medicare pays first for covered services, and Medicaid pays last.

Medicare generally does not pay for long-term care, such as extended nursing home stays or ongoing help with daily tasks. Medicaid often does. That is a big reason Medicaid matters to many older adults and their families.

What Medicaid Can Help With

What you get depends on your state and your eligibility category. Here are the main kinds of help for older adults:

  • Long-term care. Medicaid.gov describes Medicaid as the primary payer for long-term care services in the country, covering care in a range of settings, from institutions to community-based services. AARP reports that Medicaid pays for about 60% of nursing home residents.
  • Help at home. States choose whether to cover services such as in-home help and adult day care. AARP notes that all states have waiver programs for home-based care, though what they offer varies.
  • Medicare costs. If you have full Medicaid benefits, your state pays your Medicare Part B premium. Depending on your Medicaid level, it may also pay Part A premiums and your Medicare cost sharing, such as copays.
  • Drug costs. People with both Medicare and Medicaid are enrolled in a Medicare drug plan automatically and get Extra Help with drug costs.
  • Extras your state may add. States can cover additional services. For example, AARP says Maryland covers comprehensive adult dental care, while most states cover only limited emergency dental care.

Who May Qualify

There is no single national rule. In general, you must meet your state’s income and resource limits, live in the state, and meet other requirements. Resources usually means things like savings, though some items, such as your home, are often treated differently. Your state can explain how it counts them.

Older adults and Supplemental Security Income

AARP reports that people 65 or older who receive Supplemental Security Income (SSI) can be eligible, with limited resources and income of $967 a month or less (a 2025 figure; check the current amount with your state).

Long-term care

For nursing home care or similar help, AARP explains that people generally need to have few assets other than a home, and also need a level of care that is often defined as needing help with two or more daily tasks, such as bathing, dressing, eating or using the toilet. States set the exact rules.

Spending down

Medicare.gov notes that some states let you “spend down” income that is over the limit by paying medical expenses until you qualify. Ask your state whether it offers this.

Medicare Savings Programs

If your income is a little too high for full Medicaid, you may still get help paying Medicare premiums through a Medicare Savings Program, which is a form of Medicaid. We explain how these work in Medicare Savings Programs: State Help Paying Your Medicare Premiums.

Special Plans for People With Both Medicare and Medicaid

Medicare.gov says people with both coverages can choose Original Medicare or a Medicare Advantage plan. Some plans are made just for them, including Special Needs Plans, Medicare-Medicaid Plans (offered in certain states), and PACE plans. PACE helps some people who need a nursing-home level of care get that care in their community instead. Availability depends on where you live.

If you want to review your Medicare options during Open Enrollment (October 15 to December 7), see our step-by-step Open Enrollment guide.

What Is Changing: Work Requirements

Federal law passed in 2025 adds work or approved-activity requirements for some adults in Medicaid. Medicare.gov says that starting January 1, 2027 (or earlier in some states), certain adults must complete at least 80 hours a month of work or approved activities to qualify and keep coverage. Medicare.gov also states this does not apply to people with Medicare. AARP describes the requirement as applying to ages 19 to 64 and notes it could affect some people ages 50 to 64. If you are under 65 and have Medicaid, ask your state how the change applies to you.

Working while on Medicaid or SSI can raise questions of its own. For that topic, see Replace a Bill: Side Income and SSI, Medicaid or Housing Help.

How to Apply or Ask Questions

  1. Find your state Medicaid office. Medicare.gov links to state offices through Medicaid.gov, and you can search for your state’s Medicaid program on the Medicaid.gov website.
  2. Ask the office what help is available for people with limited resources. Mention both coverage and help at home if that matters to you.
  3. Gather basic paperwork before you call: proof of income, a list of savings and other resources, your Medicare card if you have one, and identification.
  4. If you have Medicare, call your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling. Find yours at shiphelp.org.
  5. For complex situations, such as planning for long-term care costs, consider speaking with a qualified elder law attorney or benefits counselor in your state.

A Safety Note

Real Medicaid and Medicare offices will not ask you to pay a fee to apply, and will not ask for gift cards, wire transfers or cryptocurrency. Be careful with unexpected calls or texts claiming to be from Medicaid or Medicare, and never give your Social Security number to someone who contacted you first. When in doubt, hang up and call the official number on your card or on the state’s website. You can report suspected fraud at ReportFraud.ftc.gov.

The Bottom Line

Medicaid is a state-run program that can help pay for health care, Medicare costs and long-term care when income and resources are limited. Because each state sets its own rules, the best next step is a short call to your state Medicaid office or your SHIP counselor. You do not need to figure it all out alone.

This article is general information, not legal, tax or financial advice. Rules vary by state and change over time. Check your own situation with your state agency, a SHIP counselor or a qualified professional.

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