Having Both Medicare and Medicaid at the Same Time

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

You are not forced to choose one or the other. Medicare and Medicaid are separate programs that can work together to cover your medical costs. People who have both are called dual may be able to access or sometimes "Medi-Medi" beneficiaries. Medicare is federal health insurance based on age or disability; Medicaid is a joint federal-state program based on income and assets. Because they have different rules, different funding sources, and different coverage, having both usually means lower out-of-pocket costs than having either one alone.

The main reason people end up with both is that they meet the requirements for each program independently. You might be 65 or older (which makes you may be able to access for Medicare) and also have income and assets low enough for Medicaid in your state. Or you might be under 65 but disabled enough to may have access to for Medicare, and still poor enough to may have access to for Medicaid. The programs do not compete — they coordinate, with Medicare paying first and Medicaid filling in gaps.

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 when you have both, and Medicaid covers costs Medicare does not pay, such as copayments, coinsurance, and some long-term care.
Income and asset limits for Medicaid vary by state, so whether you can keep Medicaid while on Medicare depends on where you live.
If you are 65 or older and have low income, you may be able to get help paying Medicare premiums and cost-sharing through Medicaid programs like QMB or SLMB.
You must report changes in income or living situation to both programs, because losing one does not automatically affect the other.

How Medicare and Medicaid work together when you have both

When you have both programs, Medicare is the primary payer. This means Medicare pays its share of your medical bills first. Medicaid then steps in as the secondary payer and covers what Medicare does not — such as your Medicare copayments, coinsurance, and deductibles. Medicaid may also cover services that Medicare does not cover at all, such as long-term care in a nursing home, personal care assistance, or dental work (depending on your state's Medicaid plan).

The coordination is automatic at the point of service. When you go to a doctor or hospital that accepts both programs, you show both your Medicare card and your Medicaid card. The provider bills Medicare first, then sends the remaining bill to Medicaid. You should not have to pay anything out of pocket for covered services, though some states' Medicaid programs do charge small copayments.

This arrangement is financially better than having Medicare alone, because Medicare has significant cost-sharing: a $240 deductible for Part A (hospital), a $164 deductible for Part B (doctor and outpatient), and 20% coinsurance for most services after you meet the deductible. Medicaid can cover all of these costs if you have both programs.

Income and asset limits that let you keep Medicaid after turning 65

Medicaid income limits are set by each state and vary widely. Some states use the federal poverty level as a benchmark; others set their own thresholds. For 2024, the federal poverty level is roughly $1,550 per month for a single person, but many states allow higher income. A few states have income limits above $2,000 per month for seniors.

Asset limits also vary by state. Some states have eliminated asset limits for seniors on Medicaid, while others still count your savings, investments, and property (excluding your home and car). If your assets exceed your state's limit, you may lose Medicaid even if your income qualifies. You should contact your state Medicaid office to learn your state's exact limits, because they change and differ significantly.

If your income or assets are slightly too high for regular Medicaid, you may still be able to get help through Medicaid spend-down programs or may have access to Medicare Beneficiary (QMB) programs, which pay some or all of your Medicare premiums and cost-sharing without the same asset limits. These programs exist in every state but have their own income thresholds, usually around 135% to 200% of the federal poverty level.

Special Medicaid programs that help pay Medicare costs

If you are 65 or older and on Medicare but your income is too high for full Medicaid, you may still be able to get help through one of these programs:

may have access to Medicare Beneficiary (QMB): Pays your Medicare Part B premium, Part A premium (if you have to pay one), and your Part A and Part B cost-sharing (copayments, coinsurance, deductibles). Income limit is roughly 100% of federal poverty level, but varies by state.
Specified Low-Income Medicare Beneficiary (SLMB): Pays your Medicare Part B premium only. Income limit is roughly 120% of federal poverty level.
may have access to Individual (QI): Pays your Medicare Part B premium if you do not may have access to for SLMB. Income limit is roughly 135% to 175% of federal poverty level, depending on the year.
may have access to Disabled and Working Individual (QDWI): For people under 65 who are disabled and lost Medicare because they returned to work. Pays your Medicare Part A premium.

These programs are run by your state Medicaid office, not by Medicare. You must apply separately; being on Medicare does not automatically enroll you. Your state Medicaid office can tell you which program you may be able to access based on your income.

What happens to your Medicaid if your income changes

Medicaid and Medicare do not automatically share information about income changes. If your income rises above your state's Medicaid limit, Medicaid will not know unless you report it or unless your state conducts a periodic review. You are required to report changes in income, living situation, or household composition to your state Medicaid office. Failing to report can result in overpayments that you may have to repay later.

Conversely, if your income drops, you should report that too, because you might become may be able to access for a higher level of Medicaid coverage or for one of the Medicare cost-sharing programs. Many people do not realize their income has fallen enough to may have access to for additional help.

Medicare does not have income limits, so changes in your income do not affect your Medicare coverage. However, your Medicare premiums may change based on your income from two years prior (this is called Income-Related Monthly Adjustment Amount, or IRMAA). If your income drops significantly, you can ask Medicare to recalculate your premiums.

How to apply for both programs or learn about you may have access to

If you are turning 65, you will apply for Medicare through Social Security or Medicare.gov. Medicare enrollment is automatic if you are already on Social Security; otherwise, you must enroll during your Initial Enrollment Period (the three months before, the month of, and the three months after your 65th birthday).

Medicaid is applied for through your state Medicaid office, not through Medicare or Social Security. You can find your state office at medicaid.gov or by calling 1-800-MEDICARE (1-800-633-4227) and asking for a referral. Some states allow you to apply online; others require you to apply in person or by mail. Application times vary, but most states process Medicaid applications within 30 to 45 days.

If you are already on Medicaid and turn 65, you do not automatically lose Medicaid. However, you must enroll in Medicare Part A and Part B during your Initial Enrollment Period. If you delay enrolling in Medicare, you may face late-enrollment penalties on your Part B premium. Your state Medicaid office can help you understand how your Medicaid coverage will change once you are on Medicare.

Situations where you might lose one program but keep the other

If your income rises above your state's Medicaid limit but you are 65 or older, you keep Medicare. Medicare has no income limit. You may lose full Medicaid coverage but still be able to access QMB, SLMB, or QI programs if your income is within their thresholds.

If you lose Medicare (for example, if you are under 65 and were on Medicare due to disability, and you return to work and lose your disability status), you do not automatically lose Medicaid. Medicaid is based on income and assets, not on Medicare status. You would keep Medicaid as long as your income and assets still may have access to.

If you move to a different state, your Medicaid coverage may change because each state sets its own income and asset limits. Medicare follows you across state lines, but Medicaid does not. You should contact your new state's Medicaid office within 30 days of moving to report your address change and confirm your coverage.

Frequently Asked Questions

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

Medicare Part A is free if you or your spouse paid Medicare taxes for at least 10 years. Part B has a monthly premium (around $164 in 2024, but higher if your income is above a certain level). Medicaid has no premium in any state. If you have both, Medicaid may pay your Medicare Part B premium through QMB or SLMB programs.

If I am on Medicaid and turn 65, do I automatically get Medicare?

No. You must enroll in Medicare yourself during your Initial Enrollment Period (three months before, the month of, and three months after your 65th birthday). If you do not enroll, you may face late-enrollment penalties. Your state Medicaid office can help you understand the enrollment process.

Can I have Medicaid in one state and Medicare in another?

Medicare is federal and works the same in all states. Medicaid is state-run, so you can only be on one state's Medicaid program at a time. If you move, you must apply for Medicaid in your new state. Your Medicare coverage continues automatically.

What if my Medicaid is denied but I think I should may have access to?

You have the right to appeal a Medicaid denial. Your state Medicaid office must send you a notice explaining why you were denied and how to request a fair hearing. You typically have 30 to 60 days to appeal, depending on your state. Contact your state Medicaid office for the appeal process.

Does having both programs affect my Medicare Advantage or Medigap options?

If you have Medicaid, you cannot enroll in a Medigap plan (supplemental insurance). However, you can enroll in a Medicare Advantage plan, though some plans have restrictions for people on Medicaid. Your state Medicaid office and Medicare can explain which plans work with your Medicaid coverage.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.