Yes, you can have both Medicaid and Medicare, and millions of 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 federal and based on age or disability; Medicaid is state-run and based on income. The two programs work together, with Medicare as your primary payer and Medicaid filling in gaps.

The main reason people end up with both is age. You become may be able to access for Medicare at 65 regardless of income. If your income is low enough, you also stay on Medicaid. Some people become dual may be able to access earlier if they are on Medicaid and then may have access to for Medicare through disability (after 24 months on Social Security Disability Insurance, or SSDI).

Key Takeaways

  • Dual may be able to access means you are enrolled in both Medicare and Medicaid at the same time, and this is legal and common.
  • Medicare pays first for covered services, and Medicaid covers what Medicare does not pay, including some costs Medicare leaves to you.
  • Income and asset limits for Medicaid vary by state, so you can have both even if your income is above the federal poverty line in some states.
  • You do not have to do anything special to coordinate the two programs — they communicate automatically once you are enrolled in both.
  • Some states offer special plans called Medicare-Medicaid Plans that combine both coverages into one plan, but this is optional.

How Medicare and Medicaid work together when you have both

When you have both programs, Medicare is always the primary payer. This means Medicare pays its share of your medical bills first. Medicaid then pays what Medicare did not cover, up to what Medicaid allows in your state.

For example: Medicare covers a doctor visit at 80 percent after you meet your deductible. You owe the remaining 20 percent. If you have Medicaid, Medicaid can pay that 20 percent. Medicaid can also cover your Medicare premiums, deductibles, and copays — costs that Medicare itself does not cover. This is why having both is often better than having Medicare alone if your income is low.

The two programs do not require you to do paperwork to connect them. Once you are enrolled in both, the billing system knows to send claims to Medicare first, then to Medicaid. Your providers see both coverages in your records.

Income and asset rules for having both

You can have both programs if you meet the income and asset limits for Medicaid in your state. These limits vary widely. Some states set the limit at 100 percent of the federal poverty line; others go much higher. In 2024, the federal poverty line for a single person is around $15,000 per year, but many states allow income well above that and still cover you under Medicaid.

Assets (savings, property, investments) also have limits under Medicaid, though these limits are the same in every state: $2,000 for a single person and $3,000 for a couple. Your home and one car do not count toward this limit. If you are over the asset limit, you cannot have Medicaid, even if your income qualifies.

The best way to know your state's exact limits is to contact your state Medicaid office or use the Medicaid.gov website, which has a state-by-state breakdown. Income and asset rules change, so checking directly is more reliable than using a number you find online.

When you become dual may be able to access through age

Most people become dual may be able to access at 65, when they turn 65 and become may be able to access for Medicare. If you are already on Medicaid when you turn 65, you stay on Medicaid as long as you still meet the income and asset rules. You are automatically enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) at 65 if you have been a U.S. citizen or permanent resident for at least five years.

You do not have to do anything to stay on Medicaid when you turn 65. Your Medicaid coverage continues without a break. Some states send a notice confirming this; others do not. If you are unsure whether you are still covered, call your state Medicaid office.

When you become dual may be able to access through disability

If you are on Medicaid and then become may be able to access for Medicare through disability, you become dual may be able to access. This usually happens 24 months after you start receiving SSDI (Social Security Disability Insurance). You do not have to be 65 to get Medicare through disability — you can be any age.

You are automatically enrolled in Medicare Part A and Part B once you have been on SSDI for 24 months. Social Security sends you a notice before this happens. Like with age-based Medicare, your Medicaid continues as long as you meet your state's income and asset rules.

Medicare-Medicaid Plans: a combined option in some states

Some states offer Medicare-Medicaid Plans (also called integrated plans or dual-may be able to access special needs plans). These combine your Medicare and Medicaid coverage into a single plan run by one insurance company. You get one ID card, one set of copays, and one customer service number.

These plans are optional. You can stay in regular Medicare and Medicaid instead if you prefer. Medicare-Medicaid Plans are available only in certain states and only to people who are dual may be able to access. If your state offers one and you want to join, you can switch during the annual enrollment period (October 15 to December 7 each year).

The advantage is simplicity: one plan, one card, one bill. The disadvantage is that you are locked into one insurance company's network of doctors and hospitals. Regular Medicare lets you see any doctor who accepts Medicare. Ask your state Medicaid office whether Medicare-Medicaid Plans are available where you live and whether they cover the doctors you use.

What happens to your coverage if your income changes

Your Medicaid coverage depends on your income staying below your state's limit. If your income rises above the limit, you lose Medicaid but keep Medicare. If your income drops back below the limit, you can regain Medicaid.

Report income changes to your state Medicaid office. Most states have a process to report changes online, by phone, or by mail. If you do not report a change and your income is actually over the limit, Medicaid can ask you to repay benefits you received while ineligible — though this is rare and usually happens only if the overpayment was large.

Your Medicare coverage does not change based on income. You keep Medicare for life once you turn 65 or after 24 months on SSDI, regardless of how much money you earn.

Frequently Asked Questions

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

You pay a Medicare Part B premium (around $165 per month in 2024, though this varies by income). If you have Medicaid, Medicaid can pay this premium for you. You do not pay a Medicaid premium — Medicaid is free. Some states charge small copays for certain services, but there is no monthly premium.

What if I lose Medicaid but keep Medicare?

You keep all your Medicare coverage. You will owe more out of pocket because Medicare does not cover everything. You may want to buy a Medigap policy (private insurance that covers Medicare gaps) or join a Medicare Advantage plan. Both have premiums and may have income limits.

Can I choose which program pays for a specific service?

No. Medicare always pays first if the service is covered by both programs. You cannot ask Medicaid to pay instead. This is set by federal law, not by your choice.

Do I need to enroll in both programs, or is it automatic?

Medicare at 65 or after 24 months on SSDI is automatic if you have been a U.S. citizen or permanent resident for five years. Medicaid is not automatic — you must meet your state's income and asset rules, and you may need to submit an application. Contact your state Medicaid office to find out whether you are enrolled.

What if I move to a different state?

Your Medicare coverage moves with you — it is federal. Your Medicaid coverage ends when you move, because each state runs its own program. You must apply for Medicaid in your new state. Your new state's income and asset limits may be different, so you might not be may be able to access even if you were may be able to access in your old state.