Yes, you can have both Medicare and Medicaid, and millions of people do

You are not forced to choose one or the other. If you meet the income and asset limits for Medicaid in your state and you are also enrolled in Medicare, you can hold both at the same time. People with both programs are called dual may be able to access or dually may be able to access. Medicare covers hospital stays, doctor visits, and some preventive care. Medicaid covers services Medicare does not pay for — like long-term care, dental work, vision care, and hearing aids — and it also pays Medicare premiums, deductibles, and copayments for people who cannot afford them.

The main reason to have both is that Medicare alone often leaves gaps. If you are 65 or older, blind, or disabled and your income is low enough, you may may have access to for Medicaid even if you already have Medicare. Each state sets its own income and asset thresholds, so what qualifies you in one state may not in another.

Key Takeaways

  • Dual may be able to access people use Medicare as their primary insurance and Medicaid as a secondary payer that covers what Medicare does not.
  • You must meet both your state's Medicaid income and asset limits and Medicare enrollment rules to hold both programs at the same time.
  • Medicaid can pay your Medicare Part B premiums and cost-sharing amounts if you cannot afford them, which is a major financial benefit for low-income seniors.
  • Some states offer special Medicaid programs designed specifically for dual may be able to access people, which may include additional services or lower out-of-pocket costs.
  • Income and asset limits vary by state and change yearly, so you need to check with your state Medicaid office to know whether you may have access to.

How Medicare and Medicaid work together when you have both

Medicare is the primary payer, meaning it processes your claim first. If Medicare covers the service and pays its share, Medicaid then looks at what Medicare did not pay and may cover the remaining balance. For example, if you have a doctor visit that Medicare covers at 80 percent, Medicaid may pay some or all of the 20 percent you would otherwise owe.

For services Medicare does not cover at all — such as dental cleanings, eyeglasses, or nursing home care — Medicaid can pay the full cost if your state's Medicaid program includes that service. This is where the real value of dual coverage shows up. A person with only Medicare might pay thousands of dollars out of pocket for a hearing aid or months in a nursing home. A person with both programs may pay little or nothing.

You do not explore for dual coverage as a single program. You enroll in Medicare separately (usually at 65, or earlier if you are disabled), and you explore for Medicaid through your state Medicaid office. Once both are active, the two programs coordinate automatically when you use health care.

Income and asset limits that determine whether you may have access to

To have Medicaid while on Medicare, your income must fall below your state's limit for seniors or people with disabilities. These limits change each year and vary widely. Some states use the federal poverty level as their cutoff; others set limits higher. A few states have no income limit at all for certain Medicaid programs for seniors, though this is rare.

Asset limits also vary by state. Most states count your savings, investments, and property (other than your home and car) toward an asset ceiling. If you are married, some states count only your assets, while others count both spouses' assets together. A handful of states have no asset limit for seniors on Medicaid, but most do. You will need to contact your state Medicaid office or visit its website to learn the exact numbers that explore to you.

Income includes Social Security, pensions, wages, and interest from savings. Some income sources are not counted — for example, some states exclude a portion of your Social Security or do not count certain types of information. The rules are specific to each state, so a general number here would mislead you.

Special Medicaid programs for people with Medicare

Many states run Medicaid programs designed specifically for dual may be able to access people. These programs often have names like "Medicare Savings Program" or "Medicaid for Seniors" and may offer benefits beyond what standard Medicaid covers. Some pay your Medicare premiums and cost-sharing. Others add services like prescription drug help or dental care.

A few states operate Medicaid managed care plans that serve only dual may be able to access people. These plans coordinate your Medicare and Medicaid benefits in one place, assign you a care manager, and sometimes offer extra benefits like transportation to medical appointments or over-the-counter health items. Whether your state offers these plans and whether you are automatically enrolled or must choose to join depends on where you live.

Your state Medicaid office can tell you which programs exist in your state and whether you meet the requirements for each one. Some programs have their own income or asset rules that are different from standard Medicaid, so it is worth asking about all the options available to you.

how the process works for Medicaid if you already have Medicare

Contact your state Medicaid office directly. You can find it through your state's health department website or by calling 211, which connects you to local health and human services programs. Have your Social Security number, proof of income (like a recent tax return or Social Security statement), and a list of your assets ready.

Some states let you explore online, by mail, or in person at a local office. Others require you to explore in person. The process usually takes two to four weeks, though it can be faster or slower depending on how quickly you submit documents and how busy your state office is.

You do not need to do anything with Medicare itself. Once Medicaid approves you, the two programs will coordinate on their own. Your Medicare card stays active, and you will receive a Medicaid card or number from your state.

What happens to your Medicare coverage when you get Medicaid

Your Medicare coverage does not change. You keep all the same benefits — hospital insurance (Part A), medical insurance (Part B), and any prescription drug coverage (Part D) you enrolled in. If you were paying a Part B premium before, Medicaid may now pay that premium for you, which reduces your out-of-pocket cost.

If you are in a Medicare Advantage plan (Part C), you can stay in it while on Medicaid, though some states encourage or require you to switch to Original Medicare so Medicaid can coordinate more easily. Ask your state Medicaid office whether your plan is compatible with Medicaid in your state.

You will still see the same doctors and use the same hospitals, as long as they accept both Medicare and Medicaid. Most do, but some do not accept Medicaid, so it is worth checking before you rely on a particular provider.

Common reasons people lose dual coverage and how to avoid it

The most common reason is a change in income or assets that pushes you above your state's limit. If you receive a raise, inherit money, or start receiving a pension, you must report it to Medicaid. Some people do not realize the change affects their coverage and lose Medicaid without knowing why.

Another reason is missing a renewal important date. Medicaid requires you to renew your coverage periodically — usually every year, though some states require it more often. If you do not respond to a renewal notice, your Medicaid ends even if you still may have access to. Keep your address current with Medicaid so you receive renewal notices on time.

Moving to a different state also ends your Medicaid. You must explore for Medicaid in your new state, and the income and asset limits may be different. Your Medicare coverage moves with you, but Medicaid does not.

Frequently Asked Questions

Do I have to pay premiums for both Medicare and Medicaid?

Medicare Part A (hospital insurance) has no premium if you or your spouse paid Medicare taxes for at least 10 years. Part B (medical insurance) has a monthly premium that varies by income. If you have Medicaid, it may pay your Part B premium for you. Medicaid itself has no premium in any state.

If I am on Medicaid, will I automatically get Medicare when I turn 65?

No. You must enroll in Medicare yourself at 65, even if you are already on Medicaid. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. If you do not enroll when you first become may be able to access, you may face a permanent penalty on your Part B premium.

Can I have Medicaid in one state and Medicare in another?

Medicare is federal and works the same everywhere, so you have one Medicare enrollment no matter where you live. Medicaid is state-run, so if you move, you must explore for Medicaid in your new state. Your Medicare coverage continues without interruption.

What if my state Medicaid program does not cover something I need, like dental work?

Medicaid benefits vary by state. If your state does not cover dental care, you would pay out of pocket or look for a separate dental discount plan. Some people in this situation move to a state with more generous Medicaid benefits, though that is a major decision and not practical for most people.

Does having both Medicare and Medicaid affect my Social Security benefits?

No. Your Social Security benefits are separate from both programs. However, your Social Security income counts toward your Medicaid income limit, so a higher benefit could push you above the threshold and disqualify you from Medicaid.