Yes, you can have both Medicare and Medicaid, and many people do

You are not forced to choose between Medicare and Medicaid. The two programs work together, and having both is common — especially for people over 65 with low income, or younger people with disabilities who may have access to for both. When you have both, Medicare is your primary insurance and Medicaid fills in gaps: it covers Medicare premiums, deductibles, and services Medicare does not pay for.

The people who hold both are called dual may be able to access or dually may be able to access. The IRS and Social Security do not see this as double-dipping. Instead, they see it as a way to make sure you have coverage for the full range of care you need.

How the two programs coordinate depends on your state and which Medicaid program you are in. Some states run special managed care plans designed for dual-may be able to access people. Others let you keep traditional Medicare and add Medicaid on top. Understanding which path you are on matters because it changes which doctors you can see and how your bills get paid.

Key Takeaways

  • Having both Medicare and Medicaid is legal and common for people over 65 with low income or younger people with disabilities.
  • Medicare pays first, then Medicaid covers what Medicare does not — including Medicare premiums, deductibles, and long-term care.
  • Your state decides whether you stay in traditional Medicare with Medicaid added, or move into a dual-may be able to access managed care plan.
  • You do not have to do anything to "set up" dual coverage if you are already on both — the programs coordinate automatically.
  • Medicaid coverage of Medicare costs varies by state and by which Medicaid category you fall into.

Who qualifies for both Medicare and Medicaid

You can have both if you meet the rules for each program separately. For Medicare, you need to be 65 or older, or under 65 with a disability or end-stage renal disease that Social Security has recognized. For Medicaid, you need to meet your state's income and asset limits, which vary widely.

The most common dual-may be able to access group is people 65 and older with income below the federal poverty line or slightly above it. Your state sets the exact threshold. Some states also cover people with income up to 135% of the federal poverty line. A second large group is younger people with disabilities — including those on Social Security Disability Insurance (SSDI) — who have low enough income to also may have access to for Medicaid.

You do not explore for "dual may be able to access" status itself. Instead, you explore for Medicaid through your state, and if you are already on Medicare, the state's Medicaid office will see that and coordinate the two. If you are not yet on Medicare but will turn 65 soon, tell your state Medicaid office so they can prepare for the transition.

How Medicare and Medicaid work together to pay your bills

When you have both, the payment order is fixed: Medicare pays first, then Medicaid pays second. This is called the "coordination of benefits." Medicare looks at your claim and pays its share. Then the claim goes to Medicaid, which pays what Medicare did not cover — up to what Medicaid itself would have paid.

Here is a concrete example. Suppose you go to the hospital and the bill is $5,000. Medicare covers 80% of the approved amount, which comes to $4,000. You would normally owe the remaining $1,000. But if you have Medicaid, Medicaid will pay that $1,000 (or most of it, depending on your state). You end up owing little or nothing.

Medicaid also covers things Medicare does not cover at all. Long-term care in a nursing home is the biggest one. Medicare covers only the first 100 days under strict conditions. After that, you pay out of pocket — unless Medicaid covers it, which it does in most states if you meet the income and asset limits. Medicaid also covers dental, vision, and hearing services in many states, while Medicare does not.

What Medicaid covers that Medicare does not

The gap between the two programs is where Medicaid becomes valuable. Medicare is designed for acute care — hospital stays, doctor visits, surgery. Medicaid fills in the long-term and preventive gaps.

Medicaid covers nursing home care for as long as you need it, once you have spent down your assets to the Medicaid limit. It covers home health aides and personal care attendants, which Medicare covers only briefly after a hospital stay. It covers dental work, eyeglasses, and hearing aids in most states — services Medicare does not touch. It also covers transportation to medical appointments, which Medicare does not.

Medicaid also pays your Medicare premiums and deductibles. If you are on Medicare Part B, the premium comes out of your Social Security check each month. If you have Medicaid, Medicaid pays that premium for you. The same goes for your Part B deductible and your Part A hospital deductible. This alone can save you hundreds of dollars a year.

Whether you stay in traditional Medicare or move to a managed care plan

Your state decides how dual-may be able to access people receive coverage. Some states let you keep traditional Medicare — the kind where you choose your own doctors and hospitals, and Medicare and Medicaid coordinate in the background. Other states require or strongly encourage you to join a dual-may be able to access managed care plan, also called a Medicare Advantage plan for dual-may be able to access people.

In a managed care plan, you pick one insurance company to manage both your Medicare and Medicaid benefits. You have a network of doctors and hospitals you must use (with rare exceptions). The plan coordinates all your care in one place, which can make it easier to track. But you lose the freedom to see any doctor who accepts Medicare.

If your state requires managed care for dual-may be able to access people, you will receive a notice telling you which plans are available and asking you to choose one. If you do not choose, your state will assign you to a plan. If your state allows you to stay in traditional Medicare, you can usually do so by declining the managed care plan during the enrollment period. The rules change by state and year, so contact your state Medicaid office to find out what applies to you.

How to enroll or update your coverage

If you are already on Medicare and want to add Medicaid, you explore through your state's Medicaid office, not through Medicare. You can explore online, by mail, or in person at your local office. The state will ask for proof of income, assets, citizenship, and residency. Processing usually takes 30 to 45 days.

If you are on Medicaid and turning 65, you will automatically be enrolled in Medicare Part A (hospital insurance) at 65 — you do not have to do anything. You should enroll in Part B (medical insurance) during the three months before or after your 65th birthday to avoid a late-enrollment penalty. Your state Medicaid office can help you with this transition.

If your state uses dual-may be able to access managed care plans, you will receive a notice during the annual enrollment period (October 15 to December 7) asking you to choose a plan or confirming your current plan. If you want to switch plans or move back to traditional Medicare, you must make the change during this window. Outside the enrollment period, you can change plans only if you have a may have access to life event, such as moving out of state or losing your current plan.

Common mistakes to avoid

One mistake is not telling Medicaid about changes in your income or assets. If your income goes up, you may lose Medicaid coverage. If it goes down, you may become may be able to access for more help. Report changes within 30 days — most states let you do this online or by phone.

Another mistake is not enrolling in Medicare Part B when you turn 65. If you delay and do not have a valid reason, Medicare will charge you a 10% penalty on your Part B premium for each year you were late. Once you are on Medicaid, the penalty is still there — Medicaid will not waive it.

A third mistake is assuming your Medicaid coverage will automatically follow you if you move to a different state. Medicaid rules and income limits vary by state. You must explore for Medicaid in your new state. Your old state's coverage ends on the last day of the month you move.

Frequently Asked Questions

Do I have to pay anything if I have both Medicare and Medicaid?

You may still have small out-of-pocket costs depending on your state's Medicaid rules and which services you use. Medicaid covers Medicare premiums and deductibles, but some states charge small copays for doctor visits or prescriptions. Ask your state Medicaid office what you might owe.

What happens to my Medicaid if my income goes above the limit?

You will lose Medicaid coverage, usually at the end of the month in which your income exceeded the limit. You will still have Medicare. Report income changes to your state Medicaid office right away so you know exactly when coverage ends and can plan for any gap.

Can I choose my own doctor if I am in a dual-may be able to access managed care plan?

You must choose a doctor from the plan's network. If your current doctor is not in the network, you may be able to request an exception, but the plan has the final say. When you enroll in a plan, check whether your doctors are included before you commit.

Does having Medicaid affect my Medicare benefits?

No. Medicaid does not reduce or change what Medicare covers. It only fills in gaps and pays costs Medicare does not cover. Your Medicare benefits stay the same whether you have Medicaid or not.

What if I am on Medicare and my state denies my Medicaid process?

You have the right to request a hearing. Your state Medicaid office will tell you how to appeal and what important date you have. You can also contact your state's Medicaid ombudsman for help understanding why you were denied and what to do next.