How to Have Both Medicaid and Medicare at the Same Time

You can have both Medicaid and Medicare — they work together, not instead of each other

If you are 65 or older, or you have a disability or end-stage renal disease, you may have Medicare. If your income and assets fall below your state's limits, you may also have Medicaid. The two programs can run at the same time. When you have both, Medicaid is called your "secondary payer" — it covers costs that Medicare does not, like copayments, coinsurance, and some services Medicare excludes entirely.

The path to having both depends on whether you already have Medicare. If you do not yet have Medicare, you must sign up for it first; Medicaid cannot replace it. If you already have Medicare and your income drops, you can apply for Medicaid through your state. The programs do not automatically coordinate, so you will need to report both to each other and to your healthcare providers.

Key Takeaways

You must be enrolled in Medicare Part A and Part B before Medicaid will cover your share of those costs.
Medicaid income and asset limits vary by state, and some states have higher limits for people over 65 or with disabilities.
You report your Medicare enrollment to your state Medicaid office, and you report your Medicaid enrollment to Social Security.
Medicaid pays Medicare premiums, deductibles, and copayments for people who meet income rules — this is called "Medicare Savings Programs" in most states.
If you turn 65 and lose employer coverage, you have 63 days to sign up for Medicare without a permanent penalty.

Medicare enrollment is the first step

You cannot have Medicaid pay for Medicare costs unless you are already enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). If you are 65 or older and not yet signed up, you must do that before you apply for Medicaid.

You sign up for Medicare through Social Security — by phone at 1-800-772-1213, online at ssa.gov, or in person at your local Social Security office. If you are already receiving Social Security retirement or disability benefits, you are usually enrolled automatically at 65. If you are not receiving benefits, you must sign up yourself. The standard enrollment period is the three months before the month you turn 65, the month you turn 65, and the three months after. If you miss this window and do not have employer coverage, you will pay a permanent 10 percent increase to your Part B premium for each year you were late.

If you have a disability or end-stage renal disease (not yet 65), the same rule applies: you must be enrolled in Medicare Part A and Part B before Medicaid will help pay for it.

Medicaid income and asset rules for people with Medicare

Each state sets its own income and asset limits for Medicaid. For people 65 and older, or with disabilities, most states use the "SSI-related" rules, which are based on Supplemental Security Income (SSI) limits. The federal SSI income limit is $943 per month for an individual (as of 2024), but your state may be higher. Some states use "Section 1634" rules, which allow higher income limits — up to 300 percent of the federal poverty level in a few states.

Asset limits also vary. Most states allow you to keep $2,000 in countable assets (as an individual) or $3,000 (as a couple), but some states have higher limits or no limit at all. Your home and one vehicle are not counted. Retirement accounts like IRAs and 401(k)s are usually not counted either, but the rules differ by state.

To find your state's exact limits, contact your state Medicaid office directly — the number is on your state's Medicaid website. You can also call 211 and ask for a local Medicaid outreach worker, who can tell you whether your income and assets meet your state's rules.

How to apply for Medicaid when you have Medicare

You apply for Medicaid through your state, not through Medicare or Social Security. Each state runs its own Medicaid program and has its own application process. Most states now allow you to apply online through their Medicaid website, by mail, by phone, or in person at a local office.

When you apply, you will need to report that you have Medicare. Bring your Medicare card or a copy of your enrollment letter from Social Security. You will also need proof of income (recent pay stubs, tax returns, or a Social Security statement), proof of citizenship or immigration status, and proof of your state residency. If you have assets, you may need to report those too.

Processing time varies by state — some take two to four weeks, others take longer if they need more information from you. Once you are approved, your Medicaid coverage usually starts on the first day of the month in which you applied, or the first day of the following month, depending on your state's rules.

Medicare Savings Programs: Medicaid paying your Medicare costs

If you have both Medicare and Medicaid, your state's Medicaid program may pay your Medicare Part B premium, and it will pay your Medicare deductibles and copayments. This is called a Medicare Savings Program (or MSP). You do not need to do anything extra to get this — once you are approved for Medicaid, your state automatically determines whether you may have access to for MSP based on your income.

There are three levels of Medicare Savings Programs, depending on your income. The may have access to Medicare Beneficiary (QMB) program covers your Part B premium, deductible, and copayments. The Specified Low-Income Medicare Beneficiary (SLMB) program covers your Part B premium only. The may have access to Individual (QI) program also covers your Part B premium, but has a higher income limit and is available only if QMB and SLMB slots are not full. Your state will tell you which program you are in when you are approved for Medicaid.

Some states also offer a program called may have access to Disabled and Working Individuals (QDWI), which helps people under 65 with disabilities who are working and have lost Medicaid because their earnings are too high.

Reporting your coverage to both programs

Once you have both Medicare and Medicaid, you must keep both programs informed of changes. If your income or assets change, report it to your state Medicaid office within 30 days — most states have an online portal or a phone number on your Medicaid card. If you move to a different state, you must apply for Medicaid in your new state; Medicaid does not transfer between states.

You should also report your Medicaid enrollment to Social Security. Call 1-800-772-1213 or visit your local Social Security office and tell them you now have Medicaid. This helps Social Security track your coverage and ensures you do not lose benefits by mistake.

Give both your Medicare card and your Medicaid card to every healthcare provider you see. Tell them you have both, so they bill correctly — Medicare first, then Medicaid for what Medicare does not cover.

What happens if you lose Medicaid but keep Medicare

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. You will still have Medicare, but you will be responsible for your Part B premium, deductibles, and copayments again. If you lose Medicaid because of income, you may be able to buy a Medigap (supplemental insurance) policy to help cover those costs — but Medigap is separate from both Medicare and Medicaid and costs extra money each month.

If you lose Medicaid for any reason, your state is required to tell you in writing and explain your options. Read that letter carefully. Some states offer a "spend-down" program, which lets you reduce your countable income by paying for medical care, so you can stay on Medicaid. Ask your state Medicaid office whether that option is available to you.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. You can have both at the same time. Medicare is federal and based on age or disability; Medicaid is state-run and based on income. They are separate programs that work together. Medicaid pays the costs Medicare does not cover.

What if I am 65 but do not have Medicare yet?

You must sign up for Medicare first. Call Social Security at 1-800-772-1213 or go to ssa.gov. Once you are enrolled in Medicare Part A and Part B, you can then apply for Medicaid in your state. If you are late signing up for Medicare, you may pay a permanent penalty on your Part B premium.

Can I apply for Medicaid and Medicare at the same time?

No. You must enroll in Medicare first through Social Security, then apply for Medicaid through your state. Medicare enrollment takes about two weeks; Medicaid processing takes two to six weeks depending on your state. You cannot skip Medicare and go straight to Medicaid.

What if my state has a waiting list for Medicaid?

Some states have waiting lists for certain Medicaid programs, but most do not have waiting lists for people 65 and older or with disabilities. Call your state Medicaid office to ask whether there is a waiting list in your state. If there is, ask whether you can be placed on it while you wait.

Do I lose Medicare if I move to a different state?

No. Medicare is federal and follows you everywhere. But Medicaid is state-run, so you must apply for Medicaid in your new state. Your new state's income and asset limits may be different, so you may not be approved even if you were approved in your old state.

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.