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

You are not forced to choose between them. If you meet the rules for both programs, you can be enrolled in both at the same time. People with both are called dual may be able to access or dually may be able to access. Medicare is a federal program based on age or disability; Medicaid is a state program based on income and assets. The two programs have separate rules, separate enrollment processes, and separate payment systems, so may have access to for one does not disqualify you from the other.

Having both programs means you have broader coverage than either one alone. Medicare covers hospital care, doctor visits, and prescription drugs (with gaps). Medicaid covers long-term care, dental, vision, and other services Medicare does not. When you have both, Medicare pays first for services it covers, and Medicaid can cover costs Medicare does not pay — like copays, coinsurance, and deductibles.

Key Takeaways

  • You can enroll in Medicare and Medicaid separately; meeting the rules for one does not prevent you from meeting the rules for the other.
  • Medicare is federal and based on age (65+) or disability; Medicaid is state-run and based on income and assets, so the two programs look at different things.
  • If you have both, Medicare pays first for covered services, and Medicaid can pay your share of costs Medicare does not cover.
  • Some states offer special Medicaid programs designed for people who are already on Medicare, with lower income limits and additional benefits.

How Medicare and Medicaid may be able to access work separately

Medicare does not ask about your income or assets. You become may be able to access for Medicare at age 65 if you or your spouse paid Medicare taxes for at least 10 years while working. You can also get Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS. Once you turn 65 or meet one of these conditions, you are may be able to access for Medicare regardless of how much money you have.

Medicaid asks about both income and assets. Each state sets its own income limit for Medicaid. In most states, the limit is around 138% of the federal poverty level, though some states have set it lower. You must also have assets below a certain threshold — usually around $2,000 for a single person, though the exact number varies by state and by the type of Medicaid program. If you meet your state's income and asset rules, you can get Medicaid even if you are not yet 65 and have never worked.

Because the two programs use different rules, it is possible to be too old for one and too young for the other, or to have too much income for one and too little for the other. But it is also possible to meet both sets of rules at the same time — and that is when you become dual may be able to access.

Who typically becomes dual may be able to access

The most common path to dual may be able to access is reaching age 65 while already on Medicaid. If you are under 65 and receiving Medicaid because your income is low, you will keep your Medicaid when you turn 65 and become may be able to access for Medicare. You will then have both programs running at the same time.

Another common path is being on SSDI and having low income. If you receive SSDI, you become may be able to access for Medicare after 24 months. If your income is also low enough to meet your state's Medicaid rules, you can have both programs before you reach 65.

People who are disabled and have low income are often dual may be able to access. So are older adults with very limited income and assets. The exact numbers vary by state because each state sets its own Medicaid income and asset limits.

How the two programs work together when you have both

When you have both Medicare and Medicaid, the programs coordinate their payments. Medicare is the primary payer, meaning it pays first for any service it covers. Medicaid is the secondary payer, meaning it pays after Medicare has paid its share.

Here is how it works in practice: you go to a doctor who accepts both Medicare and Medicaid. Medicare calculates what it will pay based on its fee schedule and pays that amount to the doctor. If there is a copay, coinsurance, or deductible that Medicare does not cover, Medicaid can pay that amount for you. This means you may have little or no out-of-pocket cost for services covered by both programs.

For services that Medicare does not cover but Medicaid does — like dental work, vision care, or long-term care — Medicaid pays as the primary payer. You do not have to choose which program to use; they work together automatically once you are enrolled in both.

State Medicaid programs for people already on Medicare

Many states have created special Medicaid programs for people who are already on Medicare. These programs are sometimes called Medicare Savings Programs (MSP) or may have access to Medicare Beneficiary (QMB) programs. They are designed to help people with very low income pay their Medicare premiums, copays, and deductibles.

To get into one of these programs, your income must be below a certain threshold — usually between 100% and 200% of the federal poverty level, depending on the program and your state. Your assets must also be below the limit, typically around $7,000 for a single person. If you meet these rules, the program pays some or all of your Medicare costs, and you also get full Medicaid coverage for services Medicare does not cover.

These programs exist in every state but have different names and slightly different rules. Your state Medicaid office or your local Area Agency on Aging can tell you whether you meet the rules for your state's program.

What you need to do to have both programs

You do not need to do anything special to coordinate the two programs once you are enrolled in both. However, you do need to enroll in each program separately, and the enrollment process is different for each.

For Medicare, you enroll through Social Security. If you are turning 65, you can enroll during your Initial Enrollment Period, which runs for three months before and three months after the month you turn 65. If you miss this window, you can still enroll later, but you may pay a permanent penalty on your premiums. If you are under 65 and on SSDI, you are enrolled in Medicare automatically after 24 months of receiving SSDI.

For Medicaid, you enroll through your state. You can apply online, by mail, by phone, or in person at your local Medicaid office. Each state has its own application form and its own rules about what documents you need to provide. If you are already on Medicaid when you turn 65 or become may be able to access for Medicare, you do not need to do anything — your Medicaid will continue, and you will be enrolled in Medicare separately.

Things that can affect your dual may be able to access

Your income or assets can change, and that can affect whether you stay may be able to access for Medicaid. If your income rises above your state's limit, you may lose Medicaid coverage even though you keep Medicare. If your assets rise above the limit, the same thing can happen. You are required to report changes in income or assets to your state Medicaid office, usually within 30 days.

Some states have Medicaid spend-down rules. If your income is slightly above the Medicaid limit, you may be able to deduct certain medical expenses from your income to bring it below the limit and stay on Medicaid. This is common for people on Medicare who have high medical costs. Ask your state Medicaid office whether your state has a spend-down program.

If you move to a different state, your Medicaid coverage does not move with you. You will need to apply for Medicaid in your new state, which may have different income and asset limits. Your Medicare coverage continues no matter where you live.

Frequently Asked Questions

Do I have to enroll in Medicare Part B if I am on Medicaid?

No, but it is usually a good idea. If you are on Medicaid and may be able to access for Medicare, you can choose not to enroll in Part B. However, if you wait to enroll later, you may pay a permanent penalty. Medicaid can help pay your Part B premium if you cannot afford it, so the cost should not be a barrier to enrolling.

What happens to my Medicaid when I turn 65 and get Medicare?

Your Medicaid continues. You do not lose Medicaid just because you become may be able to access for Medicare. You will have both programs running at the same time. You will be enrolled in Medicare automatically if you are already receiving Social Security, or you can enroll yourself if you are not.

Can I use Medicaid to pay my Medicare premiums?

Yes, if you are in a Medicare Savings Program or may have access to Medicare Beneficiary program. These state programs pay your Medicare Part B and Part D premiums, and sometimes your copays and deductibles, if your income is low enough. Not all states call these programs by the same name, so ask your state Medicaid office what programs are available.

What if my income goes up after I have both programs?

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. You will keep Medicare. You must report income changes to your Medicaid office within 30 days. Some states allow you to deduct medical expenses from your income to stay below the limit; ask your Medicaid office whether yours does.

Do I need to choose between Medicare and Medicaid doctors?

No. Most doctors accept both programs. When you have both, you can see any doctor who accepts Medicare and Medicaid. The programs coordinate payment automatically, so you do not have to manage two separate claims or figure out which program should pay.