Medicare vs Medicaid Eligibility Estimator
Estimate whether you may qualify for Medicare, Medicaid, or both based on your age, disability status, income, and household size. Results are estimates based on federal guidelines.
Formulas Used
Federal Poverty Level (FPL) — 2024, Contiguous 48 States & DC:
- FPL = $15,060 + ($5,380 × (Household Size − 1))
- Income % of FPL = (Annual Income ÷ FPL) × 100
Medicare Eligibility:
- Age ≥ 65 AND ≥ 40 quarters of Medicare-covered employment (or spouse's record)
- Any age: SSDI recipients after 24-month waiting period, or ESRD/ALS diagnosis
- Must be U.S. citizen or lawful permanent resident (5+ years)
Medicaid Eligibility (ACA Expansion States):
- Adults 19–64: Income ≤ 138% FPL
- Children under 19: Income ≤ 138% FPL (Medicaid) or ≤ 200% FPL (CHIP)
- Aged/Blind/Disabled (ABD): Income ≤ 100% FPL (SSI-linked threshold)
- Non-expansion states: categorical eligibility applies (parents, pregnant women, etc.)
Dual Eligibility: Individuals who meet both Medicare and Medicaid criteria. Medicaid may pay Medicare Part B premiums, deductibles, and co-pays via Medicare Savings Programs.
Assumptions & References
- FPL figures based on 2024 HHS Poverty Guidelines for the 48 contiguous states and D.C. (Alaska and Hawaii have higher thresholds).
- ACA Medicaid expansion threshold of 138% FPL applies in the 40+ states that have adopted expansion as of 2024.
- Non-expansion state threshold conservatively set at 100% FPL; actual limits vary by state and eligibility category.
- CHIP income threshold of 200% FPL is a federal minimum; many states extend coverage to 250–300% FPL.
- ABD Medicaid threshold approximated at 74–100% FPL based on federal SSI benefit levels ($943/month individual in 2024).
- Medicare Part A premium-free eligibility requires 40 quarters (10 years) of Medicare-taxed employment per SSA rules.
- SSDI recipients become Medicare-eligible after a 24-month waiting period from disability onset date.
- Asset/resource tests (e.g., for ABD Medicaid) are not included in this estimator.
- Sources: CMS.gov, HHS.gov, SSA.gov, KFF.org (2024 Medicaid Expansion Status).
- This tool provides estimates only and does not constitute legal or benefits counseling.