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 for people 65 and older, regardless of income. Medicaid is a joint federal-state program for people with low income, regardless of age. The two programs have different rules, different funding sources, and different coverage areas — so it is possible and common to be enrolled in both at the same time.

When you have both programs, Medicare is your primary insurance and Medicaid is your secondary. This means Medicare pays first on your medical bills, and Medicaid can help cover what Medicare does not pay — like copayments, coinsurance, and deductibles. People with both programs are sometimes called dual may be able to access or dually may be able to access.

The main reason people end up with both is age combined with low income. If you turn 65 and your income is below your state's Medicaid limit, you may be enrolled in Medicaid automatically when you sign up for Medicare. If you are already on Medicaid and turn 65, you will be moved to Medicare automatically, and you may stay on Medicaid if your income still qualifies.

Key Takeaways

  • You can be enrolled in both Medicare and Medicaid at the same time; Medicare pays first, and Medicaid covers costs Medicare does not.
  • Most people with both programs are 65 or older with income below their state's Medicaid limit.
  • When you turn 65, you must enroll in Medicare Part A and Part B, even if you are on Medicaid; missing the deadline can result in permanent penalties.
  • Your state Medicaid office handles the Medicaid part of your coverage; Social Security handles Medicare enrollment.
  • Medicaid rules and income limits vary by state, so what qualifies you in one state may not in another.

How Medicare and Medicaid work together

When you have both programs, the way they coordinate depends on which type of Medicare coverage you have. If you have Original Medicare (Part A and Part B), Medicaid can pay your Part B premiums, deductibles, and copayments. If you have a Medicare Advantage plan (Part C), Medicaid still covers some out-of-pocket costs, but the exact amounts depend on your plan and your state.

Medicaid never duplicates what Medicare covers. If Medicare pays for a service, Medicaid will not pay the full amount again — it only fills in the gaps. This is called the coordination of benefits. For example, if Medicare covers a hospital stay but you owe a $1,500 deductible, Medicaid may pay part or all of that deductible, depending on your state's rules.

Some states offer special programs for people with both Medicare and Medicaid. These programs, sometimes called Dual may be able to access Special Needs Plans (D-SNPs), combine Medicare and Medicaid benefits into one plan. Not all states offer them, and not everyone with both programs qualifies, but they can simplify your coverage if you are may be able to access.

Income and asset limits for having both programs

To have both Medicare and Medicaid, you must meet two separate sets of rules: you must be 65 or older (or disabled or blind, in some cases) for Medicare, and you must have income and assets below your state's Medicaid limit.

Medicaid income limits vary significantly by state. Some states use the federal poverty level as a starting point; others set their own limits higher or lower. For 2024, the federal poverty level for a single person is around $15,000 per year, but many states allow income up to 138% or 200% of that amount. A few states have much lower limits. You need to check your specific state's rules because the difference between may have access to and not may have access to can be just a few hundred dollars per year.

Medicaid also has asset limits in most states — a cap on how much money and property you can own and still be may be able to access. These limits are usually $2,000 for a single person and $3,000 for a married couple, though some states have higher limits or have eliminated them entirely. Your home and one car do not count toward the asset limit in most states.

Medicare has no income or asset limit. Once you are 65, you can enroll in Medicare regardless of how much money you have. But if your income is too high for Medicaid, you will have Medicare only, not both.

When you turn 65: what happens to your Medicaid

If you are currently on Medicaid and you turn 65, you must enroll in Medicare Part A and Part B. This is automatic in some cases — Social Security will contact you — but you should confirm your enrollment yourself by calling Social Security at 1-800-772-1213 or visiting ssa.gov.

After you enroll in Medicare, your Medicaid coverage does not automatically end. Your state Medicaid office will review your case to see if you still meet the income and asset limits for Medicaid. If you do, you will stay on Medicaid as a secondary payer. If you do not, your Medicaid will end, and you will have Medicare only.

The timing matters. If you miss the deadline to enroll in Medicare Part B when you first become may be able to access, you will pay a permanent penalty on your Part B premium for as long as you have Medicare. The penalty is 10% of the standard premium for each year you were may be able to access but not enrolled. This penalty does not go away, so enrolling on time is critical.

How to enroll if you want both programs

If you are 65 or older and think you might be may be able to access for Medicaid, start by contacting your state Medicaid office. You can find your state office at medicaid.gov or by calling your local social services department. Tell them your age, income, and assets, and ask whether you meet the income and asset limits for your state.

At the same time, enroll in Medicare. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your Social Security number, birth certificate, and proof of citizenship or legal residency. Enrollment in Medicare Part A is usually free if you or your spouse paid Medicare taxes while working. Part B has a monthly premium (usually around $175 per month in 2024, but this varies by income).

If you are already on Medicaid and turn 65, Social Security should contact you about Medicare enrollment. Do not wait for them to reach out — call Social Security yourself to confirm your enrollment is in process. Once you are enrolled in Medicare, your state Medicaid office will automatically review your case and let you know whether you stay on Medicaid.

What documents you will need

To apply for Medicaid, you will typically need proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of age (birth certificate or passport), proof of citizenship or legal residency (passport, naturalization papers, or state ID), and a list of your assets (bank statements, property deeds). Some states also ask for proof of residence.

To enroll in Medicare, you will need your Social Security number, birth certificate, and proof of citizenship or legal residency. If you are applying for Medicare based on disability rather than age, you will also need medical records showing your condition.

Keep copies of everything you submit. If your application is denied or delayed, you will need these documents to appeal or to reapply.

State-by-state differences that affect your coverage

Medicaid rules are not the same everywhere. Some states have expanded Medicaid to cover more people with higher incomes; others have not. Some states cover dental and vision care through Medicaid; others do not. Some states have eliminated asset limits; others still enforce them strictly.

If you move to a different state after you are enrolled in both Medicare and Medicaid, your Medicaid coverage may change. You will need to apply for Medicaid in your new state and meet that state's rules. Your Medicare coverage will follow you — it is federal and works the same way everywhere — but your Medicaid will not automatically transfer.

Before you move, contact your new state's Medicaid office and ask what the income and asset limits are, what documents you will need, and how long the application process takes. This will help you plan your move and avoid a gap in coverage.

Frequently Asked Questions

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

Medicare Part A is usually free if you or your spouse paid Medicare taxes while working. Medicare Part B has a monthly premium, usually around $175 in 2024, though it can be higher if your income is above a certain level. Medicaid has no premium in any state — it is free once you are enrolled. If you have both programs, Medicaid can help pay your Medicare Part B premium.

What if my income goes up after I am enrolled in both programs?

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage, but you will keep Medicare. You should report the income change to your state Medicaid office right away. Some states have a grace period before they end your coverage; others end it immediately. Your Medicare coverage will not change.

Can I have Medicare Advantage and Medicaid at the same time?

Yes. If you have a Medicare Advantage plan (Part C), you can still be enrolled in Medicaid. Medicaid will cover some of your out-of-pocket costs under the Advantage plan, such as copayments and coinsurance. Some states offer special Medicare Advantage plans designed for people with both programs, called Dual may be able to access Special Needs Plans.

What happens to my Medicaid if I go back to work after 65?

If you return to work and your income rises above your state's Medicaid limit, you will lose Medicaid. However, some states have work incentive programs that allow you to keep Medicaid even if your income is slightly above the limit. Contact your state Medicaid office to ask about these programs before you start working.

How long does it take to be approved for both Medicare and Medicaid?

Medicare enrollment usually takes two to four weeks once you submit your application. Medicaid approval times vary by state — some states process applications in two to three weeks, while others take six weeks or longer. If you are applying for both at the same time, plan for at least a month before your coverage is active. Some states allow you to start using Medicaid while your application is being reviewed.