Having Both Medicare and Medicaid at the Same Time

Yes, you can have both Medicare and Medicaid, and millions of people do

You are not forced to choose between them. Medicare and Medicaid operate as separate programs with different rules, and if you meet the requirements for both, you can be enrolled in both at the same time. People with both programs are called dual may be able to access or dually may be able to access.

The two programs work together in a specific order: Medicare is always your primary payer, meaning it pays first on your medical bills. Medicaid then pays some or all of what Medicare does not cover. This arrangement can significantly reduce your out-of-pocket costs, especially if you have limited income.

Whether you actually may have access to for both depends on your age, disability status, and income. Many people over 65 with low income, and some younger people on disability with low income, meet the requirements for both programs.

Key Takeaways

Medicare pays first on your medical bills, and Medicaid covers some or all of the costs Medicare leaves unpaid.
You must meet the income and other requirements for each program separately — having one does not automatically give you the other.
Your state determines which Medicaid benefits you receive and whether you pay premiums or cost-sharing amounts.
If you are over 65 or on disability and have low income, you may already may have access to for both without taking any action.
You can contact your state Medicaid office or Social Security to find out whether you meet the requirements.

Who qualifies for both Medicare and Medicaid

The most common group is people age 65 and older with income below your state's Medicaid limit. Medicare may be able to access at 65 is based on work history (yours or a spouse's), not income. Medicaid may be able to access is based on income and assets. If you turn 65, enroll in Medicare, and your income falls below your state's threshold, you can also receive Medicaid.

Younger people on Social Security Disability Insurance (SSDI) can also have both programs. You become may be able to access for Medicare automatically after receiving SSDI for 24 months. If your income is low enough, you may also may have access to for Medicaid in your state. The income limits vary by state and change yearly.

Some people may have access to through specific pathways: those who worked in government jobs without paying into Social Security, those receiving Supplemental Security Income (SSI), and those who meet other state-specific rules. Each state sets its own income and asset limits for Medicaid, so the threshold in one state may differ from another.

How the two programs pay together

When you have both programs, the payment order is fixed. Medicare processes your claim first and pays its share based on what it covers and what you have already paid toward your deductible. Medicaid then receives the claim and decides whether to pay the remaining balance.

For example, if you see a doctor and the bill is $150, Medicare might pay $100 after your deductible is met. Medicaid then receives notice of that $100 payment and typically covers the remaining $50. The exact amount Medicaid pays depends on your state's rules and the type of service.

Medicaid also covers some costs Medicare does not, such as long-term care in a nursing home (after Medicare's limited coverage ends), dental care in some states, and transportation to medical appointments. This is why dual coverage can be valuable for people with significant health needs.

Your costs when you have both programs

Having Medicaid alongside Medicare usually lowers what you pay out of pocket. Medicaid can cover your Medicare premiums (the monthly charge for Part B), your deductibles, and your copayments. In many states, if you may have access to for Medicaid, it will automatically pay these costs on your behalf.

However, your costs depend on which Medicaid category you fall into and your state's rules. Some states have different cost-sharing rules for different groups. A few states charge small copayments even for Medicaid services, though most do not charge people with very low income.

You will still have Medicare premiums unless Medicaid covers them. If you are on SSDI and receive Medicaid, your state may pay your Part B premium directly. If you are over 65 and receive both, Medicaid typically covers your premiums as part of your benefits.

How to learn about you may have access to

The fastest way is to contact your state Medicaid office directly. You can find your state office through the Medicaid website or by calling 1-800-MEDICARE (1-800-633-4227), which can transfer you to your state program. Have your Social Security number, income information, and asset details ready.

If you are already receiving Social Security or SSDI, you can also contact your local Social Security office. They can tell you whether you meet the income threshold for Medicaid in your state and direct you to apply if you do.

Some people are enrolled in Medicaid automatically. If you receive SSI (Supplemental Security Income), you are usually enrolled in Medicaid at the same time without having to apply separately. If you are unsure whether you are already covered, call your state Medicaid office with your Social Security number.

What happens if your income changes

Both Medicare and Medicaid monitor your income and assets. If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. You will still have Medicare, but you will no longer have Medicaid to help pay your premiums and out-of-pocket costs.

If your income drops again, you can reapply for Medicaid. There is no penalty for losing and regaining coverage. Report income changes to your state Medicaid office as soon as they happen, because continuing to receive Medicaid after your income exceeds the limit can result in overpayment recovery.

Some states have programs that allow people to keep Medicaid for a limited time even if their income rises slightly, usually through work incentives for people on disability. Ask your state Medicaid office whether such a program exists in your state.

Medicaid managed care and dual coverage

Many states require people with both Medicare and Medicaid to enroll in a Medicaid managed care plan, sometimes called a dual-may be able to access special needs plan (D-SNP). These plans coordinate your Medicare and Medicaid benefits through a single insurance company.

In a managed care plan, you choose or are assigned to a plan that handles both your Medicare and Medicaid coverage. The plan may limit which doctors and hospitals you can use, but it typically offers additional benefits that regular Medicaid does not, such as dental or vision care.

If your state offers managed care for dual-may be able to access people, you will receive information about your options. You can usually choose which plan to join, or you can opt out and keep traditional Medicare and Medicaid if your state allows it. Contact your state Medicaid office to understand your options.

Frequently Asked Questions

Do I have to do anything to get Medicaid if I already have Medicare?

Not necessarily. If you are over 65 and your income is low enough, you may be able to apply for Medicaid through your state office. If you receive SSI, you are usually enrolled automatically. Contact your state Medicaid office to find out whether you meet the income requirements and how to apply if you do.

Will I lose Medicare if I lose Medicaid?

No. Medicare and Medicaid are separate programs. If your income rises and you lose Medicaid, your Medicare coverage continues. You will still pay Medicare premiums and out-of-pocket costs, but you will remain enrolled in Medicare.

What if I am on Medicare and my state does not have Medicaid?

All states have Medicaid programs. However, some states have more restrictive income limits than others. If your income is above your state's limit, you will not may have access to for Medicaid even if you have Medicare. You can contact your state Medicaid office to learn the exact income threshold.

Can I choose between Medicare and Medicaid if I may have access to for both?

You cannot decline Medicare if you are may be able to access at 65, because you must enroll or face a permanent penalty on your premiums. However, you can decline Medicaid if you choose, though this is uncommon because Medicaid helps pay costs Medicare does not cover.

Does having Medicaid affect my Medicare benefits?

No. Medicaid does not change what Medicare covers. It only helps pay the costs Medicare leaves for you to pay. Your Medicare benefits remain the same whether or not you have Medicaid.

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.