Yes, you can have both Medicare and Medicaid simultaneously

People who have both Medicare and Medicaid are called dual may be able to access. This happens when someone meets the age or disability requirements for Medicare and also meets their state's income and asset limits for Medicaid. You do not choose one or the other — if you meet the requirements for both programs, you can be enrolled in both at the same time.

Medicare is a federal program run by the Centers for Medicare & Medicaid Services (CMS). Medicaid is a joint federal and state program, so the rules vary by state. When you have both, Medicare is your primary insurance and Medicaid is your secondary insurance. This means Medicare pays first on your medical bills, and Medicaid can help cover costs that Medicare does not pay.

About 12 million people in the United States are dual may be able to access. Most are either over 65 or under 65 with a disability. Having both programs can significantly reduce your out-of-pocket costs for doctor visits, hospital stays, prescriptions, and long-term care.

Key Takeaways

  • You can have Medicare and Medicaid at the same time if you meet the income and disability or age requirements for both programs.
  • Medicare pays first on your medical bills, and Medicaid covers some of the costs Medicare does not pay, including copayments and deductibles.
  • Each state sets its own Medicaid income limits, so whether you may have access to depends partly on where you live.
  • If you are dual may be able to access, you may be automatically enrolled in a Medicare Advantage plan that includes Medicaid benefits, depending on your state.

How Medicare and Medicaid work together when you have both

When you have both programs, the order of payment is fixed. Medicare always pays first. After Medicare pays its share, Medicaid looks at what is left and may pay some or all of the remaining cost. This is called the coordination of benefits.

For example, if you see a doctor and the visit costs $150, Medicare might pay $100 (after you meet your deductible). Medicaid can then pay part or all of the remaining $50, depending on your state's rules and the type of service. In some cases, Medicaid also pays your Medicare premiums, deductibles, and copayments.

The specific amounts Medicaid covers vary by state. Some states are more generous than others. Your state Medicaid office can tell you exactly what costs Medicaid will cover once you are enrolled in both programs.

Income and asset limits for dual may be able to access

To be dual may be able to access, you must meet Medicare's requirements and your state's Medicaid requirements at the same time. Medicare may be able to access is the same nationwide: you must be 65 or older, or under 65 with a disability or end-stage renal disease. The Social Security Administration determines disability status.

Medicaid income limits are set by each state and change yearly. Most states use the federal poverty level as a starting point, but some allow higher incomes. For 2024, the federal poverty level for a single person is about $15,000 per year, but many states set their Medicaid limit higher — sometimes 100% to 200% of the federal poverty level or more.

Medicaid also has asset limits in most states. Assets are things you own, like savings accounts, vehicles, and property. The limit varies by state, but many states allow you to have $2,000 in countable assets if you are single. Your home and one vehicle usually do not count toward this limit. Contact your state Medicaid office to learn the exact income and asset limits where you live.

How to learn about you may have access to in your state

The first step is to contact your state Medicaid office. You can find it through your state health department website or by calling 211, which is a free referral service that connects you to local programs. When you call, have your Social Security number, birth date, and recent income information ready.

If you are already on Medicare, you can also contact Medicare directly at 1-800-MEDICARE (1-800-633-4227). They can tell you whether you appear to meet Medicaid's requirements based on what they know about you. However, Medicare cannot enroll you in Medicaid — only your state Medicaid office can do that.

Some people are automatically enrolled in Medicaid when they turn 65 and start Medicare. This happens in a few states that have automatic enrollment processes. Even if you are not automatically enrolled, you can apply at any time during the year.

Medicaid managed care plans for dual may be able to access people

Many states require or encourage dual may be able to access people to enroll in a special type of Medicaid plan called a Medicare Advantage Dual may be able to access Special Needs Plan (D-SNP) or a Medicaid managed care plan. These plans combine Medicare and Medicaid benefits into one plan, which can make it easier to coordinate your care.

If your state offers these plans, you may be automatically enrolled in one unless you choose to opt out. The plan covers both your Medicare and Medicaid services through one insurance company. You will have one member ID card, one set of copayments, and one network of doctors and hospitals to use.

Not all states have these plans, and not all dual may be able to access people are required to use them. Some states allow you to stay in Original Medicare and separate Medicaid. Ask your state Medicaid office which option is available to you and whether you have a choice.

What costs Medicaid covers when you have both programs

When you have both Medicare and Medicaid, Medicaid can help pay for costs that Medicare does not cover fully. This includes Medicare copayments, coinsurance (the percentage of the cost you pay), and deductibles. Medicaid can also cover services that Medicare does not cover at all, such as long-term care in a nursing home or assisted living facility.

Medicaid coverage of prescription drugs varies by state. Some states use Medicaid to help pay for drugs that Medicare's drug plan does not cover. Medicaid can also help pay the monthly premium for a Medicare drug plan (Part D) if you cannot afford it.

Dental, vision, and hearing services are often covered by Medicaid but not by Medicare. If you are dual may be able to access, Medicaid may pay for these services depending on your state. Check with your state Medicaid office about what is covered in your area.

What happens to your benefits if your income or assets change

If your income or assets increase above your state's Medicaid limit, you may lose Medicaid coverage. However, you will keep Medicare because Medicare is not based on income. You should report any income or asset changes to your state Medicaid office within 30 days.

If your income decreases, you may become newly may be able to access for Medicaid or move to a different Medicaid category. Some states have programs for people with slightly higher incomes, such as the Medicaid Buy-In for Working People with Disabilities, which allows working people under 65 to keep Medicaid even if their income is above the normal limit.

Your state Medicaid office will send you a notice if your benefits change. Read these notices carefully and contact the office if you do not understand what happened or if you believe the decision is wrong.

Frequently Asked Questions

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

Most people pay a monthly premium for Medicare Part B (medical insurance). If you are dual may be able to access, Medicaid in your state may pay this premium for you. You do not pay a premium for Medicaid itself — it is free. However, you may have copayments when you use services.

What if I move to a different state?

Your Medicare coverage stays the same no matter where you live. However, Medicaid rules and income limits are different in each state. When you move, you must apply for Medicaid in your new state. Your old state's Medicaid will end, and your new state's Medicaid will begin once you are approved. Contact your new state's Medicaid office as soon as you move.

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

Yes. Many dual may be able to access people are enrolled in a Medicare Advantage plan that also includes Medicaid benefits. Some states require this, while others let you choose. If you want to stay in Original Medicare instead, you can usually opt out of the Medicare Advantage plan.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not change what Medicare covers or how much Medicare pays. Medicaid only helps cover costs that Medicare does not pay. Your Medicare benefits remain the same whether or not you have Medicaid.

How do I know which doctors accept both Medicare and Medicaid?

Most doctors who accept Medicare also accept Medicaid, but not all. If you are in a Medicare Advantage plan that includes Medicaid, use the plan's provider directory to find doctors in the network. If you have Original Medicare and separate Medicaid, ask your doctor's office whether they accept both. You can also call your state Medicaid office for a list of providers in your area.