How to Have Both Medicare and Medicaid at the Same Time

You can have both Medicare and Medicaid if you meet the income and age requirements for each program

Medicare and Medicaid are separate programs with different rules, so it is possible to be enrolled in both at once. People who have both are called dual may be able to access. You do not choose one or the other — you can hold both if you meet each program's requirements. Medicare is based mainly on age (65 and older) or disability status, while Medicaid is based on income and assets. If you are 65 or older and your income is low enough, or if you are disabled and meet Medicaid's financial limits, you may may have access to for both.

Having both programs means Medicare is your primary insurance and Medicaid is your secondary. Medicare pays first for covered services, and Medicaid covers what Medicare does not pay, including some costs Medicare leaves with you. This combination can significantly reduce your out-of-pocket costs for medical care, prescription drugs, and long-term services.

Key Takeaways

You may have access to for both programs if you meet Medicare's age or disability requirement and Medicaid's income and asset limits for your state.
Medicare pays first for any covered service, and Medicaid covers the gaps Medicare leaves, such as copayments and deductibles.
Income limits for dual may be able to access vary by state, but federal poverty guidelines are a rough benchmark — your state Medicaid office can tell you the exact threshold.
You enroll in Medicare through Social Security, and in Medicaid through your state or county, so you will work with two separate agencies.
Some states offer special Medicaid programs designed specifically for people who are dual may be able to access, which may cover services regular Medicaid does not.

Who qualifies for both Medicare and Medicaid

To be dual may be able to access, you must meet the requirements for both programs. For Medicare, you need to be 65 or older, or under 65 and receiving Social Security Disability Insurance (SSDI) or railroad retirement disability benefits for at least 24 months. For Medicaid, you must meet your state's income and asset limits. Income thresholds differ by state — some states use the federal poverty level (which changes yearly), while others set their own limits higher or lower. Your state Medicaid office publishes its current income cutoff, and you can find it by searching "[your state] Medicaid income limits" or calling your local Medicaid office.

Asset limits also vary by state. Some states count your savings, investments, and property toward a limit (often around $2,000 for an individual), while others do not count assets at all. A few states have eliminated asset limits entirely. If you are unsure whether your income and assets fall within your state's Medicaid range, contact your state Medicaid office directly — they can give you a yes or no answer based on your actual numbers.

How Medicare and Medicaid work together

When you have both programs, Medicare is always the primary payer. This means Medicare processes the claim first and pays its share of the cost. Medicaid then receives the claim and pays what Medicare did not cover. For example, if Medicare covers 80 percent of a doctor visit and you owe a 20 percent copayment, Medicaid may pay that copayment for you. If Medicare does not cover a service at all, Medicaid may cover it if your state's Medicaid program includes that service.

This coordination protects you from large bills. Without Medicaid, you would owe Medicare's deductibles, copayments, and coinsurance out of your own pocket. With Medicaid as secondary, those costs are often covered. Medicaid also covers some services Medicare does not, such as long-term care in a nursing home, personal care assistance, and dental care (in states that include these benefits).

Enrolling in Medicare when you already have Medicaid

If you are already on Medicaid and turn 65, you must enroll in Medicare Part A and Part B. You do this through Social Security, not through Medicaid. You can apply online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You should apply three months before your 65th birthday to avoid late-enrollment penalties.

Once you enroll in Medicare, notify your state Medicaid office that you now have Medicare. Medicaid will update its records and shift to secondary payer status. Some states do this automatically when they receive notice from Social Security, but it is safer to contact your Medicaid office directly to confirm the change has been made. If you are under 65 and on SSDI, you become may be able to access for Medicare automatically after 24 months of receiving benefits — you do not need to apply, but you should still notify Medicaid.

Enrolling in Medicaid when you already have Medicare

If you are on Medicare and your income drops or your circumstances change, you may become may be able to access for Medicaid. You apply for Medicaid through your state or county Medicaid office, not through Medicare. Each state has its own application process — some accept applications online, by mail, or in person. You can find your state Medicaid office by searching "[your state] Medicaid apply" or by calling 1-800-MEDICARE (1-800-633-4227), which can refer you to your local office.

When you apply, bring proof of your income (pay stubs, tax returns, or benefit statements), proof of citizenship or immigration status, and proof of your Medicare enrollment. Processing times vary by state but typically take two to four weeks. Once you are approved, Medicaid will coordinate with Medicare automatically — you do not need to do anything else.

Special Medicaid programs for dual may be able to access people

Some states offer Medicaid programs specifically designed for people who are dual may be able to access. These programs may include additional benefits that regular Medicaid does not cover, such as vision care, hearing aids, or more generous long-term care coverage. Two common examples are Medicare Savings Programs and Medicaid Buy-In programs.

Medicare Savings Programs help pay your Medicare premiums, deductibles, and copayments. You must be on Medicare and have income below a certain level (usually around 135 to 200 percent of federal poverty level, depending on your state). Medicaid Buy-In programs let working people with disabilities keep Medicaid even if their earnings would normally disqualify them. Ask your state Medicaid office whether you are in a state that offers these programs and whether you meet the requirements.

What happens to your coverage if your income changes

If your income rises above your state's Medicaid limit, you will lose Medicaid but keep Medicare. Your out-of-pocket costs for Medicare services will increase because you will no longer have Medicaid to cover deductibles and copayments. If your income drops again, you can reapply for Medicaid at any time — there is no waiting period between losing and regaining coverage.

If your income drops below the limit, reapply as soon as possible. Some states have simplified renewal processes for people who are dual may be able to access, so the reapplication may be faster than the initial one. Keep your state Medicaid office informed of any major changes in your income, living situation, or health status, because these can affect your Medicaid status.

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 while working. Part B has a monthly premium (around $165 in 2024, but this changes yearly). If you are dual may be able to access, Medicaid usually pays your Part B premium for you. Medicaid itself has no premium. You may still owe copayments and coinsurance for some services, depending on your state's Medicaid rules.

Can I use any doctor if I have both Medicare and Medicaid?

You can see any doctor who accepts Medicare. If you also want to use Medicaid benefits, the doctor should accept Medicaid too. Most doctors accept both, but some accept only one. When you call to make an appointment, ask whether the doctor accepts both Medicare and Medicaid. If a doctor accepts only Medicare, you can still see them, but Medicaid will not help pay the bill.

What if I am on Medicare and my state says I do not may have access to for Medicaid?

Income limits vary widely by state. If your state's Medicaid program does not cover you, you may still be able to get help through a Medicare Savings Program, which has higher income limits than regular Medicaid. Call 1-800-MEDICARE to find out whether you may have access to for a Medicare Savings Program in your state.

Do I need to do anything special when I turn 65 if I am already on Medicaid?

Yes. You must enroll in Medicare Part A and Part B through Social Security before or at age 65. Then tell your state Medicaid office that you now have Medicare so they can update your file and make Medicaid your secondary payer. If you do not enroll in Medicare on time, you may face late-enrollment penalties that increase your Part B premium permanently.

Can I have both Medicare Advantage and Medicaid?

Yes. Medicare Advantage is a type of Medicare plan offered by private insurance companies. If you are dual may be able to access, you can enroll in a Medicare Advantage plan, and Medicaid will still be your secondary payer. Some states offer special Medicare Advantage plans designed for dual may be able to access people that include extra benefits like dental or vision. Ask your state Medicaid office or call 1-800-MEDICARE to learn whether your state has these plans.

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.