Medicaid āŗ Turning 65
I’m turning 65 and I have Medicaid. What changes?
For anyone who gets Medicaid through their state’s coverage for adults under 65. By the end you’ll know what changes at your birthday, how Medicare and Medicaid work together, and what to do in the months before.
At 65 you no longer fit Medicaid’s adult group, so your state re-checks you under its rules for older adults and people with disabilities. In most states those rules include a savings limit, often $2,000 for one person. Before your state ends your coverage, it must check whether a program that pays your Medicare costs can help you.
Why does my Medicaid change at 65?
States that expanded Medicaid cover adults ages 19 to 64 in what federal rules call the adult group (42 CFR 435.119). Many people know it as “Medicaid expansion.” The group is only for people under 65 who don’t have Medicare Part A or Part B.
The adult group has no savings test. Your state looks at your income only. Once you turn 65, or get Medicare, you need to qualify a different way.
What rules apply after 65?
Your state re-checks you under its rules for older adults and people with disabilities. Two things change:
- Your savings count. In most states the limit follows the SSI (Supplemental Security Income) standard: $2,000 for one person and $3,000 for a couple. Some states set a different limit.
- Your income is counted a different way. The income rules for the adult group don’t apply once you’re 65.
Under the SSI rules most states follow, your home doesn’t count toward the savings limit while you live in it. Money in the bank does.
This is the change few people hear about. Savings you were allowed to have at 64 can cost you full Medicaid at 65.
Will I lose all my help?
Not necessarily. Before ending your Medicaid, your state must consider every way you might qualify. In a 2017 bulletin, CMS told states this includes the Medicare Savings Programs: state programs that pay some or all of your Medicare costs.
For example, the fullest program, called QMB, pays your Part B premium ($202.90 a month in 2026), your Part A premium if you pay one, and your Medicare deductibles and copays. In 2026, it is open to one person with monthly income up to $1,350 and savings up to $9,950. Its savings limit is higher than the $2,000 most states use for full Medicaid. See all four programs and their limits.
If your state moves you from full Medicaid to a Medicare Savings Program only, you have the right to appeal. This is called a fair hearing. Check your letter for how to ask and by when.
Do I have to sign up for Medicare?
It depends on whether you already get Social Security.
- If you get Social Security (or Railroad Retirement) benefits starting at least 4 months before you turn 65, Medicare.gov says you get Part A and Part B automatically. Your Medicare card comes in the mail about 3 months before coverage starts.
- If you don’t, you sign up yourself. Your first chance is the Initial Enrollment Period. It lasts 7 months: the 3 months before the month you turn 65, your birthday month, and the 3 months after.
Sign up before your birthday month, and Part B starts the month you turn 65. Sign up later in the window, and it starts the month after you sign up.
Medicare.gov tells people with Medicaid to check with their state Medicaid program. Ask whether the state will sign you up for Medicare or whether you need to do it, and how your Medicaid will change. Many states ask Medicaid members to sign up for Medicare when they become eligible. If your state sends you a letter about Medicare, follow it and keep a copy.
Signing up is how the two programs fit together. Medicaid.gov says services covered by both are paid by Medicare first, with Medicaid filling in the difference. If you keep full Medicaid, it pays second.
To check your own dates, see Medicare.gov’s sign-up page or call 1-800-MEDICARE (1-800-633-4227).
What about my prescriptions?
Once you have Medicare, you get Extra Help with drug costs automatically if you have full Medicaid, get help with your Part B premium through a Medicare Savings Program, or get SSI. You don’t need to apply separately.
In 2026, Extra Help means a $0 drug deductible and copays of no more than $5.10 for generics and $12.65 for brand-name drugs. People with full Medicaid and the lowest incomes pay less: no more than $1.60 and $4.90.
What should I do before I turn 65?
Start 3 months before the month you turn 65, when your Medicare sign-up window opens.
- Sign up for Medicare, unless you’re already getting Social Security and will be enrolled automatically. Follow any letter from your state about Medicare.
- Watch your mail. Your state Medicaid office will re-check you. Answer any renewal letter by the date it gives. Make sure the state has your current address.
- Gather your statements. Pull recent statements for your bank and other accounts. Your state may ask for them now that savings count.
- Ask about the Medicare Savings Programs. Say: “If I don’t qualify for full Medicaid, please check me for a Medicare Savings Program.”
- Get advice before moving money. If you’re over the limit, don’t give money to family to get under it without help. Gifts can delay Medicaid nursing home coverage later because of the 5-year look-back.
Free, unbiased Medicare counselors (SHIP) can walk you through Medicare sign-up and the Medicare Savings Programs. Find yours at shiphelp.org or call 877-839-2675.
Next step: Find your state Medicaid office, how to apply and who to call.
Find your state āRelated
Sources. 42 CFR 435.119 (adult group), 435.603 (income rules) and 435.916(f)(1) (eCFR, current as of Nov 10, 2026) Ā· CMS, Informational Bulletin, “Strategies to Streamline Transitions for Medicaid-eligible Beneficiaries Who Newly Qualify for Medicare” (June 7, 2017) Ā· 20 CFR 416.1205 and 416.1212 (SSI resource rules) Ā· CMS, “Updated 2026 SSI and Spousal Impoverishment Standards” (Apr 27, 2026) Ā· Medicare.gov, “Medicare Savings Programs” (2026 limits) Ā· Medicare.gov, “Help with drug costs” Ā· CMS, CY 2027 Rate Announcement, Table V-2 (Apr 6, 2026) Ā· CMS, 2026 Medicare Parts A & B premiums and deductibles (Nov 14, 2025) Ā· Medicaid.gov, Medicare and Medicaid enrollees eligibility page Ā· Medicare.gov, “How do I sign up for Medicare?”, “When can I sign up for Medicare?” and “When does Medicare coverage start?” (undated; read Nov 12, 2026) Ā· 42 CFR 407.14 (Initial Enrollment Period) and 407.17 (automatic enrollment) Ā· shiphelp.org.
Last verified: November 12, 2026. The 2027 Medicare Savings Program limits and Part B premium aren’t out yet. We update this page when they are.
Benefits Insider is an independent publisher, not a government agency. This page is general information, not legal or financial advice for your situation. Medicaid rules after 65 vary by state. For a decision on your case, contact your state Medicaid office or 1-800-MEDICARE.