Medigap and Medicaid are separate programs, and most Medigap plans will not cover you if Medicaid is your primary insurance
Medigap (also called Medigap supplemental insurance) is designed to fill gaps in Medicare coverage — it is not designed to work with Medicaid. If you are enrolled in Medicaid, most insurance companies will not sell you a Medigap plan, because Medigap assumes Medicare is your main coverage. Some states have created their own limited programs that work alongside Medicaid, but these are rare and have strict income and asset limits.
The confusion arises because both programs help pay medical costs, and both names sound similar. But they work in opposite directions: Medicare is federal insurance based on age or disability; Medicaid is state-run insurance based on income. Medigap fills Medicare's gaps. It does not fill Medicaid's gaps, and it does not layer on top of Medicaid.
Key Takeaways
- Medigap plans are sold by private insurance companies and are designed only for people whose primary insurance is Medicare, not Medicaid.
- If you have both Medicare and Medicaid (called "dual may be able to access"), your Medicaid typically acts as your secondary payer, and Medigap is usually not needed or available.
- A small number of states offer programs called Medicaid Buy-In or similar plans that provide limited supplemental coverage for people on Medicaid, but these are not Medigap and have strict financial limits.
- If you are on Medicaid alone (without Medicare), Medigap will not cover you; Medicaid itself is your primary insurance.
When you have both Medicare and Medicaid
If you are enrolled in both programs — a status called dual may be able to access — Medicaid becomes your secondary payer. This means Medicare pays first, and Medicaid covers some of what Medicare does not pay. In this situation, most Medigap insurers will not sell you a plan because Medicaid is already doing the job Medigap would do.
Some insurance companies will sell Medigap to dual-may be able to access people, but it is uncommon and varies by state. If you are dual may be able to access, contact your state Medicaid office to ask whether Medigap is available to you and whether it would save you money. Often it will not, because Medicaid's cost-sharing is already minimal or zero.
If you have Medicaid alone, without Medicare
Medigap will not cover you. Medigap only works with Medicare. If Medicaid is your only insurance, Medicaid itself is your primary coverage, and you do not need or may have access to for Medigap. Medicaid covers hospital, doctor, and prescription drug costs according to your state's Medicaid rules, not according to Medigap rules.
If you feel Medicaid's coverage has gaps — for example, if a service you need is not covered in your state — contact your state Medicaid office or a Medicaid managed care plan representative to discuss what is covered and what your options are. They can explain what Medicaid will and will not pay for in your situation.
State Medicaid Buy-In and similar programs
A handful of states offer programs that provide limited supplemental coverage to people on Medicaid. These programs go by names like Medicaid Buy-In, Medicaid Spend-Down, or Medicaid Continuation, depending on the state. These are not Medigap; they are state-created programs that work only within that state's Medicaid system.
These programs typically have strict income and asset limits, and they cover specific gaps in Medicaid (such as cost-sharing or certain services). If you live in a state that offers one, your Medicaid caseworker or your state Medicaid website will tell you whether you meet the requirements. These programs are rare, and most states do not offer them.
How to know what you actually need
The first step is to understand which insurance you have. If you receive a Medicare card in the mail, you have Medicare. If you are enrolled in your state's Medicaid program, you have Medicaid. You can have one, both, or neither.
If you have Medicare only, Medigap may reduce your out-of-pocket costs. If you have Medicaid only, Medigap will not cover you. If you have both, Medicaid usually handles the secondary payment, and Medigap is rarely useful or available. Contact your state Medicaid office or your Medicare counselor (through your State Health Insurance Assistance Program, or SHIP) to discuss what coverage you have and whether additional insurance makes sense for your situation.
What happens if you try to buy Medigap while on Medicaid
Most Medigap insurers will deny your application if you list Medicaid as your insurance. Some may ask you to drop Medicaid before they will sell you a plan, which is not a good trade-off — Medicaid usually provides more comprehensive coverage than Medigap alone.
If an insurer does sell you Medigap while you are on Medicaid, read the policy carefully. Some policies have clauses that limit or deny payment if Medicaid is also paying. You could end up paying Medigap premiums for coverage that does not actually work the way you expect.
Frequently Asked Questions
Can I have both Medigap and Medicaid at the same time?
Technically yes, but it is not practical. Most Medigap insurers will not sell to you if you have Medicaid. If you do have both, Medicaid pays second, and you will likely be paying Medigap premiums for coverage you do not need. Check with your state Medicaid office before purchasing Medigap.
If I am on Medicaid, what covers the gaps in my Medicaid coverage?
Medicaid itself is your primary insurance, so there is no secondary payer to fill gaps. If a service is not covered by your state's Medicaid program, you will need to pay out of pocket or find a provider who offers reduced-cost care. Contact your state Medicaid office to learn what is and is not covered.
I am turning 65 and have Medicaid. Do I need to buy Medigap?
When you turn 65, you become may be able to access for Medicare. At that point, you may have both Medicare and Medicaid (dual may be able to access). Medigap is rarely needed in this situation because Medicaid will pay as your secondary insurance. Talk to your state Medicaid office and your Medicare counselor about your options before buying anything.
What is the difference between Medigap and Medicaid?
Medicare is federal insurance for people 65 and older or with certain disabilities. Medigap is private supplemental insurance that fills Medicare's gaps. Medicaid is state-run insurance for people with low income. They are three different programs with different rules and different purposes.