Medicaid Sunshine Health

Can Someone on Sunshine Health (Medicaid) Qualify for Medicare Under Age 65?

Short answer: Sometimes — but not automatically.

Medicaid (Sunshine Health in Florida)

Sunshine Health is a Medicaid managed care plan in Florida.

Medicaid eligibility is based on income and assets, and many people under age 65 qualify because of:
• Disability
• Pregnancy
• Low income

Being enrolled in Medicaid (including Sunshine Health) does not automatically qualify someone for Medicare.

Medicare Eligibility Rules (Under Age 65)

Medicare normally begins at age 65, but individuals under 65 may qualify early if they meet certain medical or disability conditions.

Someone under 65 may qualify for Medicare if:
• They have received Social Security Disability Insurance (SSDI) for 24 months
• They have End-Stage Renal Disease (ESRD) and require dialysis or a kidney transplant
• They have Amyotrophic Lateral Sclerosis (ALS / Lou Gehrig’s disease)
– Medicare begins the same month disability benefits start

Putting It Together

If someone is under age 65 and enrolled in Sunshine Health (Medicaid):
• They do not qualify for Medicare just because they have Medicaid
• They must meet one of the Medicare disability or medical condition requirements listed above

Once they do qualify for Medicare:
• Having Medicaid at the same time makes them dual eligible (Medicare + Medicaid)
• Dual eligibility may allow access to D-SNP Medicare Advantage plans, which can include additional benefits

Key Takeaway

• Medicaid alone under age 65 ≠ Medicare eligibility
• Early Medicare requires a qualifying disability or medical condition
• Medicare + Medicaid together may open the door to D-SNP plans

Important Information & Disclosure

Anthony's Healthcare provides Medicare education and guidance only. We are not affiliated with or endorsed by the U.S. government, the federal Medicare program, the U.S. Department of Veterans Affairs (VA), or any state Medicaid agency, or any insurance carrier.

Medicare consists of multiple parts (Part A, Part B, Part C, and Part D), each with its own rules, costs, and coverage limitations. Medicare Advantage (Part C), Prescription Drug Plans (Part D), Medicare Supplement (Medigap) policies, and Special Needs Plans (D-SNP, C-SNP) are offered by private insurance companies that are approved and regulated by Medicare.

Coverage, premiums, deductibles, copayments, coinsurance, provider networks, formularies, service areas, and extra benefits may vary by plan, carrier, county, and contract year and are subject to change. Extra benefits such as dental, vision, hearing, fitness programs, transportation, over-the-counter allowances, food or grocery benefits, meals, and in-home services are not guaranteed and may have limitations or eligibility requirements.

We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

Medicaid, Medicaid managed care plans (such as Sunshine Health), Medicare eligibility under age 65, and Dual Eligible Special Needs Plans (D-SNP) are administered by Medicare, Social Security, or the appropriate state or federal agency. Eligibility, income and asset limits, and program availability vary by state and individual circumstances and are determined solely by the appropriate agency.

Information provided is for educational purposes only and does not guarantee eligibility, coverage, or enrollment.