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

You are not forced to choose one or the other. Medicare is a federal health insurance program based on age or disability status. Medicaid is a joint federal-state program based on income and other factors. The two programs operate separately, cover different things, and have different rules — so it is entirely possible to be enrolled in both at once. When you have both, Medicare is your primary insurance and Medicaid acts as a secondary payer, covering some of what Medicare does not.

People with both programs are sometimes called "dual may be able to access" or "dually may be able to access." This status is common among older adults with low incomes and among younger people who may have access to for both disability-based Medicare and income-based Medicaid. Having both can reduce your out-of-pocket costs significantly, because Medicaid can pay Medicare premiums, deductibles, and copayments that you would otherwise owe yourself.

Key Takeaways

  • You can hold both Medicare and Medicaid at the same time; they are separate programs with different may be able to access rules.
  • Medicare pays first, then Medicaid can pay some of the costs Medicare does not cover, reducing what you owe out of pocket.
  • Dual may be able to access is most common among people over 65 with low incomes or people under 65 who may have access to for both disability-based Medicare and income-based Medicaid.
  • Each state runs its own Medicaid program with different income limits and rules, so whether you can get both depends partly on where you live.
  • You must meet the separate may be able to access requirements for each program — having Medicare does not automatically may have access to you for Medicaid, and vice versa.

How Medicare and Medicaid work together when you have both

When you are enrolled in both programs, Medicare is always the primary payer. This means Medicare processes your claim first and pays its share of the cost. Medicaid then looks at what Medicare did not pay and may cover some or all of the remaining balance, depending on your state's rules and what service you received.

For example, if you see a doctor and the visit costs $100, Medicare might pay $80 (after you meet your deductible). You would normally owe the remaining $20 as a copayment. If you have Medicaid as well, Medicaid may pay that $20 copayment, leaving you with nothing to pay. However, what Medicaid covers varies by state and by the type of service, so the outcome is not the same everywhere.

This secondary coverage is one of the main financial benefits of dual may be able to access. Medicaid can also pay your Medicare Part B premium (currently $164.90 per month in 2024, though this amount changes yearly) and your Part D prescription drug premium, which would otherwise come out of your pocket.

Who qualifies for both Medicare and Medicaid

To have both programs, you must meet the separate may be able to access rules for each one. For Medicare, you must be 65 or older, or under 65 and receiving Social Security Disability Insurance (SSDI) for at least 24 months, or have end-stage renal disease or ALS. Medicare may be able to access does not depend on income.

For Medicaid, you must meet your state's income and asset limits. These limits vary significantly by state. Some states have higher income thresholds than others, and some states have expanded Medicaid under the Affordable Care Act while others have not. Your state of residence matters — a person with the same income might may have access to for Medicaid in one state but not in another.

The most common scenario for dual may be able to access is an older adult (65 or older) whose income is low enough to meet their state's Medicaid limit. Another common scenario is a person under 65 who receives SSDI (which qualifies them for Medicare after 24 months) and whose income is low enough for Medicaid. Some people also become dual may be able to access through Supplemental Security Income (SSI), which can may have access to them for both programs in many states.

Income and asset limits vary by state

Medicaid income limits are set by each state, not by the federal government. In 2024, the federal poverty level for a single person is $14,580 per year, but states can set their Medicaid income limit higher or lower than this. Some states allow income up to 138% of the federal poverty level (about $20,120 for a single person), while others set the limit much lower.

Additionally, most states have asset limits for Medicaid — meaning you can only have a certain amount of money or property and still may have access to. These limits also vary by state. Some states count your home and one vehicle as exempt assets (meaning they do not count against the limit), while others have different rules. You will need to check your specific state's Medicaid program to know whether your income and assets fall within the limits.

Because these rules change and differ so much by location, the best way to find out whether you can have both programs is to contact your state Medicaid office directly or call 211 (a free referral service) to be connected to local resources that can review your situation.

How to enroll if you think you may have access to for both

If you already have Medicare and think you might also may have access to for Medicaid, you do not need to do anything special to "apply for both." Instead, you contact your state Medicaid program and go through their intake process. You will need to provide proof of your income (such as recent pay stubs, tax returns, or Social Security statements), proof of your assets, and proof of your citizenship or immigration status. You will also need to report that you already have Medicare.

If you are turning 65 and becoming may be able to access for Medicare, you can apply for Medicaid at the same time through your state program. Some states allow you to apply online, by mail, or in person at a local office. The process and timeline vary by state.

If you are under 65 and receiving SSDI, you may already be enrolled in Medicare automatically after 24 months of receiving benefits. You can then apply for Medicaid separately through your state program. Some states have streamlined this process so that people receiving SSI are automatically enrolled in Medicaid, but this is not true everywhere.

What happens to your coverage if circumstances change

Your dual may be able to access can change if your income increases, your assets increase, or if you move to a different state. If your income rises above your state's Medicaid limit, you will lose Medicaid coverage but keep Medicare. If your income drops again later, you can reapply for Medicaid.

If you move to a different state, you will need to apply for Medicaid in your new state, because each state runs its own program with its own rules and income limits. Your Medicare coverage moves with you automatically, but your Medicaid does not.

You are required to report changes in income, assets, household size, or living situation to your state Medicaid program. The timing for reporting varies by state — some require monthly reports, others quarterly or annually. Failing to report changes can result in overpayment, which the state may ask you to repay, or loss of coverage.

Managed care and dual may be able to access programs

Some states offer special managed care plans designed specifically for people with dual may be able to access. These plans coordinate Medicare and Medicaid benefits and may offer additional services like dental, vision, or transportation. If you are dual may be able to access, your state may automatically enroll you in one of these plans, or you may have the option to choose one.

These dual may be able to access managed care plans can simplify your coverage because you work with one insurance company instead of managing Medicare and Medicaid separately. However, the plans vary by state and by provider, so what is available to you depends on where you live. You can contact your state Medicaid office or call 1-800-MEDICARE to learn what plans are available in your area.

Frequently Asked Questions

If I have Medicare, do I automatically get Medicaid?

No. Medicare and Medicaid are separate programs with separate may be able to access rules. Having Medicare does not automatically may have access to you for Medicaid. You must meet your state's income and asset limits for Medicaid separately. You can contact your state Medicaid office to find out whether you may have access to based on your specific situation.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not change your Medicare coverage or benefits. Medicare remains your primary insurance. Medicaid simply helps pay some of the costs that Medicare does not cover, such as copayments and premiums. Your Medicare benefits stay the same whether or not you have Medicaid.

What if I live in a state that has not expanded Medicaid?

States that have not expanded Medicaid typically have lower income limits for adults without disabilities. You may still may have access to for Medicaid if you are 65 or older, blind, disabled, pregnant, or caring for a dependent child, depending on your state's specific rules. Contact your state Medicaid office to learn what categories of people can enroll in your state.

Can I have both Medicare and Medicaid if I am working?

Yes, if your income is low enough to meet your state's Medicaid limit. Some states disregard a portion of work income when calculating Medicaid may be able to access, meaning you can earn more and still may have access to. The rules vary by state and by your age and disability status, so you will need to check with your state Medicaid program about how work income affects your may be able to access.

What should I do if I think I have lost Medicaid coverage?

Contact your state Medicaid office immediately to find out why your coverage ended. Common reasons include a change in income, a missed report deadline, or a change in household size. You may be able to reapply or appeal the decision. Keep any notices you receive from Medicaid, as they will explain your options for requesting a review.