Who Qualifies for Both Medicare and Medicaid at the Same Time

People who have both Medicare and Medicaid are called dual may be able to access

You can have both programs at the same time. Medicare is a federal health insurance program for people 65 and older, regardless of income. Medicaid is a state program that covers people with low income. If you are 65 or older and your income and assets fall below your state's limits, you may have both.

The same is true if you are under 65 but receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). After you have received SSDI for 24 months, Medicare begins automatically. If your income is low enough, your state's Medicaid program may cover you at the same time.

When you have both, Medicare is your primary insurance — it pays first. Medicaid covers what Medicare does not pay, including copayments, coinsurance, and deductibles. Medicaid may also cover services Medicare does not, such as long-term care or dental work, depending on your state.

Key Takeaways

You must be 65 or older, or receiving SSDI or SSI, to have Medicare; you must also meet your state's income and asset limits to have Medicaid.
If you receive SSDI, Medicare starts automatically after 24 months; Medicaid may be able to access depends on your state's rules and your current income.
Medicare pays first when you have both programs; Medicaid then covers costs Medicare leaves behind, such as copayments and deductibles.
Your state determines whether you are dual may be able to access and what extra services Medicaid will cover beyond what Medicare pays.

Income and asset limits for dual may be able to access

Your income must fall below your state's Medicaid threshold. For people 65 and older, most states use the Federal Poverty Level (FPL) as a starting point, but the exact limit varies by state. Some states set the limit at 100% of FPL; others go higher. A few states have different rules for people who are blind or disabled.

Assets also matter. Most states have an asset limit of $2,000 for an individual and $3,000 for a couple, though some states have higher limits or no limit at all. Assets include savings, investments, and property you own — but not your primary home or one vehicle. If you are over the asset limit, you will not be dual may be able to access in most states, even if your income is low enough.

Your state Medicaid office can tell you the exact income and asset limits that apply to you. You can find your state office through the Medicaid website or by calling 211.

How Medicare and Medicaid work together

When you have both programs, the order of payment is fixed. Medicare always pays first for services it covers. After Medicare pays its share, Medicaid reviews the bill. If there is a remaining balance — a copayment, coinsurance, or deductible — Medicaid may pay it.

For example, if you see a doctor and Medicare covers 80% of the visit, you normally owe a 20% coinsurance. If you have Medicaid, it may pay that 20% so you owe nothing. However, Medicaid will only pay if the doctor accepts Medicaid and if the service is covered under your state's Medicaid plan.

Some services are covered by only one program. Medicare covers hospital stays and doctor visits. Medicaid in most states covers long-term nursing home care, personal care assistance, and some dental and vision services that Medicare does not. When you have both, you get the broadest coverage available.

How to know if you are dual may be able to access

If you are already receiving both Medicare and Medicaid, you are dual may be able to access. You will have a Medicare card and a Medicaid card (or your state may use a different name for its Medicaid card).

If you have Medicare but are not sure whether you have Medicaid, contact your state Medicaid office. You can find the phone number by calling 211 or visiting your state's Medicaid website. Have your Social Security number and income information ready.

If you are turning 65 and expect to be dual may be able to access, you can contact your state Medicaid office before you turn 65 to ask about the process. Some states let you apply early; others require you to apply after Medicare begins. Do not wait until after you turn 65 to ask, because the timing varies.

Enrollment in Medicare when you receive SSI or SSDI

If you receive Supplemental Security Income (SSI), you already have Medicaid in most states — it is automatic. When you turn 65, you must enroll in Medicare Part A and Part B. You can do this at your local Social Security office, online at Medicare.gov, or by calling 1-800-MEDICARE.

If you receive SSDI, Medicaid is not automatic. After you have received SSDI for 24 months, Medicare Part A begins automatically — you do not have to do anything. However, you must still apply for Medicaid through your state if you want it. Your state will check your income and assets to see whether you meet the limits.

Some people who receive SSDI have income above their state's Medicaid limit and therefore are not dual may be able to access. Others have income below the limit and can have both. Your state Medicaid office will tell you whether you may have access to.

What dual may be able to access means for your costs

Having both programs usually means lower out-of-pocket costs than having Medicare alone. Medicare has deductibles and copayments; Medicaid often covers these. However, you still may owe money if a service is not covered by either program or if you see a provider who does not accept Medicaid.

Some dual may be able to access people pay nothing for covered services. Others pay small copayments set by their state's Medicaid program. The exact amount depends on your state's rules and the type of service.

If you are dual may be able to access and receive help paying Medicare premiums through a Medicare Savings Program, your state Medicaid office handles that. You do not pay the Part B premium; Medicaid pays it for you. Some states also help with Part D (prescription drug) premiums and cost-sharing.

Frequently Asked Questions

Can I have Medicare without Medicaid?

Yes. Many people 65 and older have Medicare but not Medicaid because their income or assets are above their state's Medicaid limits. Medicare does not have income limits. You can have Medicare alone if you are 65 or older or have received SSDI for 24 months, regardless of how much money you have.

What happens to my Medicaid if my income goes up?

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. You will keep Medicare. You should report the income change to your state Medicaid office right away so they can update your case. Some states have a grace period before coverage ends; others end it immediately.

Do I need to do anything to stay dual may be able to access?

Yes. You must keep your Medicaid active by reporting changes in income, living situation, or household size. Most states require you to recertify your Medicaid may be able to access once a year. You will receive a notice in the mail telling you when to recertify. If you do not respond, your Medicaid may end even if you still may have access to.

Can I choose which program pays first?

No. Medicare always pays first by law. You cannot ask Medicaid to pay first or change the order. However, you can choose which doctors and hospitals you use, and you should make sure they accept both Medicare and Medicaid before you schedule an appointment.

What if my state does not have a Medicaid program?

All states have Medicaid programs. However, the rules and income limits are different in every state. If you move to a different state, you must apply for Medicaid in that state. Your coverage does not transfer automatically.

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.