Medicaid › Before Medicare

I’m on Social Security but don’t have Medicare yet. Can Medicaid cover me?

For people who claimed Social Security at 62 to 64, and people on disability benefits (SSDI) who are waiting for Medicare. By the end you’ll know whether Medicaid can cover you until Medicare starts, and what to do this month.

Who can get Medicaid before Medicare?

Medicaid is health coverage run by each state with federal funding. Many states cover the expansion group: adults ages 19 to 64 who are not on Medicare and have income at or below 138% of the federal poverty level. The federal poverty level is an income line that the U.S. Department of Health and Human Services sets every January.

Limits are higher in Alaska and Hawaii. Your state publishes its own monthly figures and may switch to the new year’s numbers on a different date, so check your state’s page.

Your state counts income using tax-based rules called MAGI (modified adjusted gross income). For this group, your savings, home and car are not counted at all.

Does my Social Security count as income?

Yes. Under MAGI rules, Social Security counts, including SSDI, and including any part that isn’t taxed. HealthCare.gov says to enter “the full amount before any deductions,” so use your benefit before anything is taken out, not the amount that lands in your bank. SSI does not count.

What if my state didn’t expand Medicaid?

Not every state covers the expansion group. If yours doesn’t, income alone may not be enough to qualify. You may still qualify another way, such as through SSI (covered below). Your state Medicaid office can tell you which groups it covers.

HealthCare.gov explains a gap here. Premium tax credits for Marketplace plans start at 100% of the federal poverty level. In a state that hasn’t expanded Medicaid, an adult with income below that line who doesn’t qualify for Medicaid another way (for example, through a disability or age) usually can’t get either one. HealthCare.gov calls this falling “into a gap.”

HealthCare.gov still suggests filling out a Marketplace application, because a closer look at your income may put you in the range for help. If your income rises later, you may qualify then. Start at HealthCare.gov’s Medicaid expansion page.

Does the new work rule apply to me?

If you’re 19 to 64 and in the expansion group, most states must start a work rule by January 1, 2027: 80 hours a month of work, volunteering, school or job training, or at least $580 a month in income. Many people are exempt, including caregivers and people who are medically frail, which includes being blind or disabled under SSI’s definition.

Read the full work-rule guide, including the exemption list and how to keep your coverage.

I’m on SSDI. When does Medicare start?

SSDI (Social Security Disability Insurance) is the disability benefit you earn by working. Medicare comes after a wait:

• SSDI payments usually start after a 5-month waiting period.
• Medicare then starts in your 25th month of SSDI benefits. That is roughly 29 months after your disability began.
• If you have ALS, Medicare starts as soon as your disability benefits start.

Medicare starts automatically. Until then, Medicaid or a Marketplace plan can cover you. When Medicare begins, you leave the expansion group, and your state must check whether you qualify for other Medicaid or for help paying your Medicare costs before it ends your coverage. See SSDI, SSI, Medicare and Medicaid.

I get SSI. Do I get Medicaid?

SSI (Supplemental Security Income) is a monthly payment for people with very low income and savings who are disabled, blind or 65 and older. In most states it comes with Medicaid:

• 34 states and Washington, D.C.: Social Security decides your Medicaid along with your SSI. No separate application.
• 8 states (Alaska, Idaho, Kansas, Nebraska, Nevada, Oklahoma, Oregon and Utah): you file a separate Medicaid application with your state.
• 8 states (Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota and Virginia): the state decides under its own rules. Ask your state how to apply.

More in SSDI, SSI, Medicare and Medicaid.

What if my income is too high for Medicaid?

You can buy a plan on the Health Insurance Marketplace at healthcare.gov. It will show whether you qualify for a premium tax credit, which is help paying your monthly premium.

What should I do this month?

1. Check whether your state covers the expansion group on your state’s page.
2. Add up your household’s monthly income and compare it with the limits above.
3. Apply as soon as you need coverage. For applications made on or after January 1, 2027, Medicaid for this group pays bills only back to the month before you apply.
4. If you’re on SSDI, mark your 25th month of benefits on your calendar. That’s when Medicare starts.
5. If you’re already on Medicaid, find your renewal month. Starting in 2027, this group renews every 6 months.
6. If your income is too high, compare plans at healthcare.gov.
7. Turning 65 within a year? Read what changes at 65.

Related

Benefits Insider is an independent publisher, not a government agency. This page is general information, not legal or financial advice for your situation. For a decision on your case, contact your state Medicaid office, or Social Security at 1-800-772-1213 for SSDI and SSI.