Yes, you can have both Medicare and Medicaid
You can hold both Medicare and Medicaid at the same time. In fact, millions of people do. When you have both programs, they work together to cover your medical costs — Medicare is your primary insurance, and Medicaid fills in gaps like copayments, deductibles, and services Medicare does not cover. The person holding both is sometimes called dual may be able to access.
Having both programs does not require you to choose one or the other. If you meet the income and asset limits for Medicaid in your state and you are already on Medicare (or become may be able to access for it), you can be enrolled in both. The programs operate separately but coordinate their payments when you receive care.
Key Takeaways
- You can hold Medicare and Medicaid simultaneously if you meet your state's Medicaid income and asset limits and are age 65 or older, disabled, or have end-stage renal disease.
- When you have both, Medicare pays first, then Medicaid covers what Medicare does not, including deductibles and copayments.
- Each state sets its own Medicaid income limits, so whether you may have access to depends on where you live and your household income.
- You do not need to do anything special to coordinate the programs — your providers report to both automatically once you are enrolled in each.
How Medicare and Medicaid work together
Medicare is a federal program based on age (65 and older), disability, or end-stage renal disease. Medicaid is a joint federal and state program based on income and assets. When you have both, the order of payment is fixed: Medicare processes your claim first as the primary payer, then Medicaid processes what remains as the secondary payer.
For example, if you see a doctor and Medicare covers 80 percent of the cost after you meet your deductible, Medicaid can pay your share of the remaining 20 percent. If Medicare does not cover a service at all — such as long-term care or dental work in many states — Medicaid may cover it if your state's Medicaid program includes that service. This layering reduces your out-of-pocket costs significantly compared to having Medicare alone.
Providers do not need you to manage this coordination. Once both programs have your information, claims flow to Medicare first, then to Medicaid automatically. You present your Medicare card at the time of service, and the billing department handles the rest.
Income and asset limits vary by state
Medicaid income limits are set by each state and change yearly. Some states use the federal poverty level as a baseline; others set limits higher or lower. To know whether your income qualifies, you need to check your specific state's current limits, not a national figure.
Asset limits also vary. Most states have a limit of $2,000 in countable assets for an individual, but some states have higher limits or different rules for certain types of assets. Your home and one vehicle are usually not counted. Savings, stocks, and other liquid assets typically are counted.
Because you already receive Medicare, you do not need to re-prove age or disability to Medicaid. You only need to show that your income and assets fall within your state's Medicaid limits. Contact your state Medicaid office or use your state's online portal to find the current limits and begin the process of determining whether you meet them.
Who qualifies for both programs
You can have both Medicare and Medicaid if you are age 65 or older, or if you are under 65 and receive Medicare because you are disabled or have end-stage renal disease. Additionally, your income and countable assets must fall within your state's Medicaid limits.
Some people become dual may be able to access automatically. If you are already on Medicaid and turn 65, you become may be able to access for Medicare at that age. Your Medicaid coverage continues as long as you still meet the income and asset test. Similarly, if you are on Medicare and your income drops below your state's Medicaid limit — for instance, after retirement or a job loss — you may become newly may be able to access for Medicaid.
Others must apply for Medicaid separately. If you are on Medicare but have never applied for Medicaid, you can do so through your state Medicaid office at any time. There is no deadline or enrollment period for Medicaid the way there is for Medicare.
How to apply for Medicaid if you already have Medicare
Start by contacting your state Medicaid office. You can find the phone number and online portal on your state's health department website. When you call or apply online, tell them you are already on Medicare and want to know if you meet the income and asset limits for Medicaid in your state.
You will need to provide proof of income (recent pay stubs, tax returns, or a Social Security statement), proof of assets (bank statements), proof of citizenship or immigration status, and proof of your Medicare enrollment. Some states allow you to upload documents online; others require you to mail them or bring them in person to a local office.
Processing time varies by state, typically ranging from two to four weeks. Some states offer expedited processing if you are in urgent need of coverage. Once approved, your Medicaid coverage begins on the first day of the month in which you were approved, or sometimes retroactively to cover medical bills from the previous month.
What Medicaid covers that Medicare does not
Medicaid covers many services that Medicare does not, though the exact list depends on your state. Common gaps that Medicaid fills include long-term care in nursing homes, personal care assistance, dental care, vision care, and hearing aids. Some states also cover transportation to medical appointments, which Medicare does not.
Medicaid also covers the cost-sharing that Medicare requires. This means Medicaid pays your Medicare deductibles, copayments, and coinsurance. For someone on a fixed income, this can mean the difference between being able to afford care and skipping it.
Your state Medicaid program publishes a list of covered services. Review it to understand what additional coverage you gain by having Medicaid alongside Medicare. If a service is not listed, it is not covered by that state's Medicaid program, though you can sometimes appeal or request a coverage information.
Changes in income or assets that affect both programs
If your income or assets change after you are enrolled in both programs, you must report the change to Medicaid. Most states require you to report within 10 to 30 days. If your income rises above your state's Medicaid limit, you will lose Medicaid coverage, though Medicare continues. If your assets exceed the limit, the same applies.
Conversely, if your income drops further, you remain covered. Medicaid does not end if your income decreases; it only ends if it rises above the limit or if you no longer meet other requirements (such as citizenship or residency).
Report changes by contacting your state Medicaid office or using your state's online portal. Keep records of the change — a new pay stub, a letter from Social Security, or a bank statement — to support your report. Failure to report can result in overpayment recovery or loss of coverage retroactively, so do not delay.
Frequently Asked Questions
Do I have to choose between Medicare and Medicaid?
No. You can have both at the same time if you meet the requirements. There is no rule forcing you to pick one. In fact, having both usually gives you better coverage than either program alone because Medicaid covers gaps in Medicare.
Will having Medicaid affect my Medicare benefits?
No. Medicare benefits do not change when you add Medicaid. Medicaid simply pays costs that Medicare does not cover. Your Medicare coverage, premiums, and benefits remain the same.
What happens if I move to a different state?
Medicaid is state-based, so your coverage ends when you move. You must apply for Medicaid in your new state using that state's income and asset limits, which may be different. Medicare continues regardless of where you live. Contact your new state's Medicaid office within 30 days of moving to avoid a gap in coverage.
Can I have Medicaid if I am on Medicare but still working?
Yes, if your income is low enough to meet your state's Medicaid limit. Some states have higher limits for working people or people with disabilities. Check your state's current limits to see if your work income qualifies.
Do I need to pay premiums for Medicaid if I already have Medicare?
Most people do not pay a Medicaid premium. Medicaid is free for those who meet the income and asset test. However, you continue to pay Medicare premiums (Part B and Part D, if applicable) as usual.