You keep both programs, but Medicare becomes your primary insurance

When you turn 65 and enroll in Medicare, you do not lose Medicaid. Instead, you become may be able to access for both at the same time, and they work together. Medicare covers hospital care, doctor visits, and some prescription drugs. Medicaid continues to cover services Medicare does not pay for — like long-term care, dental work, and vision care — and it picks up costs Medicare leaves behind, such as copayments and deductibles.

This combination is called dual coverage, and it is common. About 12 million people in the United States have both programs. The key difference is that Medicare pays first for anything it covers, and Medicaid pays second. You will use your Medicare card at the doctor's office, and Medicaid handles what Medicare does not.

Your Medicaid coverage does not stop automatically when Medicare starts. You keep the same Medicaid card and the same benefits you had before, unless your state makes a change based on your new Medicare status. Some states adjust what Medicaid covers once you have Medicare, but they do not remove you from the program.

Key Takeaways

  • Medicaid does not end when you turn 65 and get Medicare; both programs continue at the same time.
  • Medicare is your primary payer for hospital and doctor services, and Medicaid covers costs Medicare does not, including long-term care and copayments.
  • You must enroll in Medicare Part A and Part B when you turn 65, or you may face penalties and gaps in coverage.
  • Your state Medicaid office will know whether your coverage changes once Medicare starts, so contact them after you enroll in Medicare.

How Medicare and Medicaid work together

When you have both programs, Medicare handles the bill first. If you go to the doctor and the visit costs $100, Medicare pays its share (usually 80 percent after you meet your deductible), and Medicaid pays the remainder, including your copay. This is called the coordination of benefits.

Medicaid also covers services Medicare does not offer at all. Nursing home care, personal care assistance, hearing aids, and dental work are examples. If you need long-term care, Medicaid is often the program that pays for it, because Medicare only covers short-term skilled nursing care after a hospital stay.

The two programs use different rules and different networks of doctors. Your Medicare coverage works the same way nationwide, but your Medicaid coverage depends on your state. Some states cover more services than others, and some states have different copayments. When you move to a new state, your Medicaid changes but your Medicare does not.

You must enroll in Medicare Part A and Part B

Enrollment in Medicare is not automatic, even if you have Medicaid. You must sign up for Medicare Part A (hospital insurance) and Part B (doctor and outpatient care) when you turn 65. If you do not enroll on time, you will pay a penalty for the rest of your life — 10 percent more per month for Part B, and 2 percent more per month for Part A.

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The enrollment window is seven months long: three months before the month you turn 65, the month itself, and three months after. If you miss this window and do not have other health coverage, you will have to wait until the next general enrollment period (January 1 through March 31 each year) to sign up.

Once you enroll in Medicare Part A and Part B, tell your state Medicaid office. They need to know so they can update your file and make sure your Medicaid coverage coordinates correctly with Medicare. Some states do this automatically when Medicare starts, but others require you to report it.

What your state Medicaid office does after you get Medicare

Each state runs its own Medicaid program, so the rules vary. Some states automatically adjust your Medicaid benefits once Medicare begins. Others keep your coverage exactly the same. A few states have special programs for people with both Medicare and Medicaid, sometimes called Medicare Savings Programs, that help pay your Medicare premiums and cost-sharing.

Contact your state Medicaid office within a month of enrolling in Medicare to confirm your coverage is still active and to ask whether anything changes. Your Medicaid office can tell you which services are still covered, what your copayments are, and whether you may have access to for any programs that help with Medicare costs.

If your income or assets change after you turn 65, your Medicaid status might change too. Medicaid has income and asset limits, and Medicare does not. If your income rises above your state's limit, you could lose Medicaid even though you have Medicare. Your state Medicaid office will tell you what the limits are and what counts toward them.

Medicare Part D and Medicaid prescription drug coverage

When you turn 65, you also need to choose prescription drug coverage. Medicare Part D is the prescription drug plan, and you must enroll when you turn 65 or pay a penalty. If you already have Medicaid, Medicaid may have been covering your prescriptions, but once Medicare starts, Medicare becomes the primary payer for drugs.

You can enroll in a Medicare Part D plan during the same seven-month window as Parts A and B. Your state Medicaid office can tell you which Part D plans work best with your Medicaid coverage in your state. Some plans coordinate better with Medicaid than others, and your Medicaid office may have a list of recommended plans.

After you enroll in Part D, Medicaid will cover any costs that Part D does not — such as copayments for drugs that Part D covers, or drugs that Part D does not cover but your state Medicaid does. This is another example of how the two programs work together to fill gaps.

What happens if you delay Medicare enrollment

If you turn 65 and do not enroll in Medicare because you think Medicaid will cover everything, you will face problems. Medicaid expects Medicare to be your primary payer once you are 65. If you do not have Medicare, Medicaid may refuse to pay, or it may pay less than it would if Medicare were in place.

Additionally, if you miss the enrollment window and do not have other health coverage, you cannot enroll in Medicare again until the next general enrollment period. This means you could go months without any coverage at all, or with only Medicaid, which is not designed to be your sole insurance after 65.

The penalty for late enrollment is permanent. Even if you enroll later and catch up, you will pay the extra amount for the rest of your life. For this reason, it is important to enroll in Medicare Part A and Part B during your initial enrollment window, even if you have Medicaid.

Frequently Asked Questions

Do I have to pay Medicare premiums if I have Medicaid?

Yes, you pay Medicare Part B premiums (currently around $165 per month, though this changes yearly) unless your income is very low. Some states have Medicare Savings Programs that pay your Part B premium for you if you meet their income limits. Contact your state Medicaid office to see if you may have access to.

Can I drop Medicaid once I have Medicare?

You can request to drop Medicaid, but most people do not, because Medicaid covers services Medicare does not — especially long-term care. If you drop Medicaid and later need nursing home care or other Medicaid services, you will have to reapply and meet the income and asset limits again.

What if I move to a different state after I turn 65?

Your Medicare coverage stays the same in every state. Your Medicaid coverage changes to your new state's program. Contact your new state's Medicaid office within 30 days of moving to report your address and confirm your coverage continues. Benefits and copayments may be different in your new state.

Will Medicaid pay for Medicare Part B if I cannot afford it?

Some states have Medicare Savings Programs that pay Part B premiums, deductibles, and copayments for people with low income. You must meet your state's income limit to may have access to. Your state Medicaid office can tell you whether you meet the threshold and how to apply.

What if I do not turn 65 until after I already have Medicare?

This does not happen — Medicare may be able to access starts at 65. However, if you are under 65 and have a disability or end-stage renal disease, you may already have Medicare. In that case, you keep both Medicare and Medicaid when you turn 65, and the same coordination rules apply.