You can have both Medicare and Medicaid if you meet income and asset limits for Medicaid while also being old enough or disabled enough for Medicare

People who hold both programs are called dual may be able to access. Medicare is a federal program based on age (65 and older) or disability status, while Medicaid is a state program based on income and assets. The two programs operate separately, but if you meet the requirements for both, you can be enrolled in both at the same time. Medicare becomes your primary payer for most medical bills, and Medicaid fills in gaps — covering costs Medicare does not pay.

Dual may be able to access is common. Millions of Americans receive both programs because they are older or disabled and also have low enough income and assets to meet their state's Medicaid rules. The combination often means lower out-of-pocket costs than either program alone, because Medicaid can cover Medicare premiums, deductibles, and copayments.

Key Takeaways

  • You must meet Medicare's age or disability requirement and your state's Medicaid income and asset limits at the same time to be dual may be able to access.
  • Medicare pays first for covered services, and Medicaid covers costs Medicare leaves unpaid, such as premiums and deductibles.
  • Income limits for Medicaid vary by state, and some states have expanded programs that cover more people than others.
  • If you are already on Medicaid and turn 65, you are automatically enrolled in Medicare Part A and Part B unless you decline.
  • Dual may be able to access individuals often pay less out of pocket than people on Medicare alone, because Medicaid covers many of Medicare's cost-sharing amounts.

How Medicare and Medicaid work together when you have both

When you are dual may be able to access, the two programs coordinate to pay your medical bills. Medicare is always the primary payer, meaning it pays its share first. Medicaid then pays what Medicare does not cover, up to what Medicaid allows. This arrangement protects you from very high out-of-pocket costs.

For example, if you need a hospital stay that costs $10,000, Medicare might cover $8,000 after you meet your deductible. You would normally owe the remaining $2,000 plus your deductible. If you are on Medicaid, Medicaid can pay your Medicare deductible and the remaining $2,000, leaving you with little or no bill. The exact amount Medicaid covers depends on your state's rules and the type of service.

Medicaid also covers services Medicare does not cover at all, such as long-term care in a nursing home or assisted living facility. This is one of the biggest reasons dual may be able to access matters — Medicare has strict limits on how long it pays for skilled nursing care, but Medicaid can cover years of custodial care if you meet the income and asset test.

Income and asset limits that determine Medicaid may be able to access

To be dual may be able to access, you must fall within your state's Medicaid income and asset limits. These limits vary significantly by state. Some states use the federal poverty level as a benchmark, while others set their own thresholds. A few states have expanded Medicaid to cover people with higher incomes, while others maintain stricter limits.

Income includes Social Security, pensions, wages, and other regular payments. Assets include bank accounts, stocks, real estate (except your primary home), and vehicles. Most states allow you to own your home and one car without counting them against your asset limit. The asset limit itself ranges from around $2,000 to $10,000 depending on the state, though some states have higher limits for people over 65 or with disabilities.

Your state's Medicaid office can tell you the exact income and asset limits that apply to you. You can also contact your local Area Agency on Aging or call 211 to find your state's Medicaid contact information. Income and asset limits change periodically, so it is worth checking every year or whenever your financial situation changes.

What happens to your Medicaid when you turn 65 and become may be able to access for Medicare

If you are already receiving Medicaid and turn 65, you become may be able to access for Medicare Part A (hospital insurance) and Part B (medical insurance). The Social Security Administration automatically enrolls you in both unless you decline. You will receive a Medicare card in the mail before your 65th birthday. Your Medicaid coverage continues at the same time.

You do not have to do anything to coordinate the two programs — they work together automatically. However, you should review your Medicaid coverage after you turn 65 to understand how your benefits change. Some states have special Medicaid programs designed for people who are both old and poor, and you may be moved into one of these programs. Your coverage should not end, but the specific benefits or cost-sharing amounts might shift.

If you are working and have employer health insurance when you turn 65, you can delay enrolling in Medicare Part B without penalty as long as your employer has 20 or more employees. However, if you are on Medicaid, you should still enroll in Medicare Part A at 65 because it has no premium and Medicaid will benefit from having Medicare as the primary payer.

How to learn about you meet your state's Medicaid rules

The first step is to contact your state's Medicaid office directly. You can find the contact information by visiting Medicaid.gov and selecting your state, or by calling 211 and asking for your state Medicaid agency. Have your Social Security number, income information, and asset information ready when you call.

Many states also allow you to check your potential may be able to access online through their Medicaid website. You enter your income and household size, and the system tells you whether you likely meet the income limit. This is not a formal information, but it gives you a quick sense of whether it is worth applying.

If you are already on Medicaid and want to know whether you will remain may be able to access when you turn 65 or if your circumstances change, ask your caseworker directly. They can review your situation and tell you what will happen. If you are on Medicare and think you might now meet your state's Medicaid income limit, you can apply to Medicaid at any time — there is no enrollment period.

Special Medicaid programs for people who are old and disabled

Many states have created Medicaid programs specifically for people who are 65 or older or who are blind or disabled. These programs often have higher income limits than regular Medicaid, making it easier for older adults to stay on Medicaid even if their income rises slightly. Common names include Medicaid for the Elderly and Disabled, Aged and Disabled Medicaid, or similar titles that vary by state.

Some states also have programs that allow people to keep more assets than the standard Medicaid limit. For example, a state might allow someone over 65 to own a home and have $10,000 in liquid assets instead of the usual $2,000. These programs exist because policymakers recognized that older adults often have modest savings and should not be forced to spend down their life savings to receive care.

If you are 65 or older and your income is slightly above your state's regular Medicaid limit, ask your Medicaid office whether an aged and disabled program exists in your state. You might be able to get coverage through that program even if you do not meet the standard limit.

Costs you avoid when you have both programs

Dual may be able to access can significantly reduce your out-of-pocket costs. Medicare Part B has a monthly premium (currently over $160 for most people, though the exact amount changes yearly). Medicaid can pay this premium for you. Medicare also has an annual deductible for Part B services and copayments for doctor visits and other care. Medicaid covers these costs when you are dual may be able to access.

The biggest financial protection comes from Medicaid's coverage of long-term care. Medicare pays for skilled nursing care for up to 100 days after a hospital stay, but only if you meet strict conditions. After that, you pay out of pocket unless you have long-term care insurance. Medicaid, by contrast, can pay for years of nursing home care or assisted living if you meet the income and asset test. For many older adults, this is the difference between staying in their home with help and losing their savings to pay for care.

Medicaid also covers dental care, vision care, and hearing aids in most states — services Medicare does not cover. If you are dual may be able to access, you can receive these services through Medicaid at little or no cost.

Frequently Asked Questions

Can I have Medicare without Medicaid?

Yes. Medicare is based on age or disability, not income. You can be on Medicare alone if your income is too high for Medicaid or if you do not meet your state's asset limits. Many people on Medicare alone pay higher out-of-pocket costs because they cover their own premiums, deductibles, and copayments.

What if I am on Medicare and my income drops — can I get Medicaid?

Yes. You can apply for Medicaid at any time if your income falls below your state's limit. There is no enrollment period for Medicaid. Contact your state Medicaid office or call 211 to start the process. If you are approved, Medicaid will cover costs Medicare does not pay.

Do I have to choose between Medicare and Medicaid?

No. If you meet the requirements for both, you can have both. You cannot decline one to keep the other. If you are 65 and on Medicaid, you are automatically enrolled in Medicare Part A and Part B unless you actively decline Part B (though declining is usually not advisable).

Will I lose my Medicaid if my income increases slightly?

It depends on how much your income increases and your state's rules. Some states have programs for older adults that allow higher income limits. Others have a process called spend-down, where you can use medical expenses to reduce your countable income. Ask your Medicaid caseworker what happens if your income changes.

How do I know which program pays for a specific service?

Medicare pays first for services it covers. If Medicare covers the service and you have met your deductible, Medicare pays its share. Medicaid then pays what Medicare does not cover. If Medicare does not cover the service at all, Medicaid may cover it if your state's Medicaid program includes it. Your provider's billing office can tell you which program will pay for a specific service.