You can keep Medicaid after you enroll in Medicare, but the rules depend on your state and your income

When you turn 65 and enroll in Medicare, Medicaid does not automatically end. In fact, many people hold both at the same time. Medicare becomes your primary insurance — it pays first — and Medicaid can cover costs that Medicare does not, like copayments, coinsurance, and deductibles. But whether you keep Medicaid depends on whether you still meet your state's income and asset limits, which do not change just because you turned 65.

The key difference is that at 65, you move from Medicaid rules based on disability or your state's adult income threshold to Medicaid rules based on age. Most states have a higher income limit for people 65 and older than they do for working-age adults, so you may actually become newly may be able to access for Medicaid at 65 even if you were not may be able to access before. Other people lose Medicaid at 65 because their income is now above the older-adult threshold. Your state Medicaid office will review your case when you turn 65 or when you report a change.

Key Takeaways

  • Medicaid does not end when you enroll in Medicare at 65; you can hold both if you meet your state's income and asset limits for people 65 and older.
  • Medicare pays first, and Medicaid can cover your share of costs — copays, coinsurance, and deductibles — that Medicare does not pay.
  • Your state's income limit for Medicaid may be higher at 65 than it was when you were younger, so you might become newly may be able to access.
  • You must report your Medicare enrollment to your state Medicaid office so they can update your case; do not assume they know automatically.
  • If you lose Medicaid at 65, you can ask about programs like may have access to Medicare Beneficiary (QMB) that help pay Medicare costs based on a higher income threshold.

How your income is counted when you turn 65

When you are on Medicaid before 65, your income limit is set by your state and usually applies to working-age adults or people with disabilities. At 65, you move into the older-adult category, and most states use a different — and usually higher — income limit for that group. Social Security income, pensions, wages, and interest all count toward the limit, but some income is not counted, such as the first $20 of most unearned income per month and the first $65 of wages per month (these are federal "disregards" that most states use).

Your assets also matter. Most states have an asset limit for Medicaid — often around $2,000 for a single person — but the rules for what counts as an asset vary. Your home, one car, and certain personal items do not count. Bank accounts, stocks, and other liquid assets do. If you are married and only one spouse is on Medicaid, the rules for "spousal impoverishment" may protect some of your spouse's income and assets from the Medicaid calculation.

When you turn 65, your state Medicaid office should send you a notice asking you to report your current income and assets. If your income has changed or you have reached 65, report it promptly. Do not wait for them to ask — if you do not report and your income is now above the limit, you could lose coverage retroactively and owe back premiums.

What happens to your Medicaid coverage when you enroll in Medicare

Enrolling in Medicare Part A and Part B does not automatically change your Medicaid status. However, you must tell your state Medicaid office that you have enrolled in Medicare. Some states do this automatically if they see the enrollment in federal records, but others do not, so it is safer to report it yourself by calling your state Medicaid office or submitting a change-of-circumstances form online or by mail.

Once Medicaid knows you have Medicare, it will recalculate your case based on your current income and the older-adult income limit. If you still may have access to, your Medicaid will continue. Your Medicaid card will stay active, and you will use both cards when you see a doctor or go to the hospital. Medicare pays first, then Medicaid pays its share of what Medicare does not cover.

If your income is now above the older-adult limit, you will lose Medicaid. Your state will send you a notice with an end date, usually 30 days away. This does not affect your Medicare coverage — Medicare continues regardless — but you will lose the help Medicaid was providing with your out-of-pocket costs.

How Medicaid and Medicare work together

When you have both Medicaid and Medicare, the two programs coordinate to reduce what you pay out of pocket. Medicare is the primary payer, meaning it processes your claim first and pays its share. Medicaid is the secondary payer and covers costs that Medicare does not, including Medicare copayments, coinsurance, and deductibles.

For example, if you see a doctor and Medicare covers 80 percent of the cost, you would normally owe 20 percent coinsurance. If you have Medicaid, Medicaid can pay that 20 percent (or part of it, depending on your state's rules). The same applies to hospital stays, prescription drugs, and other services both programs cover. You do not have to do anything to make this work — you just show both cards and the providers bill the programs in the right order.

Medicaid may also cover services that Medicare does not, such as long-term care in a nursing home, personal care information, and dental or vision care (though coverage varies by state). This is one reason keeping Medicaid at 65 is valuable: it fills gaps in Medicare coverage.

If you lose Medicaid at 65, you may still have options

If your income is above your state's Medicaid limit for people 65 and older but you cannot afford your Medicare costs, you may be able to get help through a federal program called may have access to Medicare Beneficiary (QMB). QMB pays your Medicare Part B premiums, deductibles, and coinsurance if your income is below a certain threshold — usually higher than the Medicaid limit. Each state runs its own QMB program, so income limits and covered costs vary.

To explore QMB, contact your state Medicaid office or call 1-800-MEDICARE. You do not need to have had Medicaid before to explore for QMB. There are also other programs like Specified Low-Income Medicare Beneficiary (SLMB) and may have access to Individual (QI) that help with different Medicare costs if your income is slightly higher than QMB's limit.

If you lose Medicaid and do not may have access to for QMB or another program, you will be responsible for your Medicare copayments and coinsurance. Some people choose to buy a Medigap (supplemental insurance) plan to cover these costs, though Medigap premiums can be high. Talk to a counselor at your State Health Insurance information Program (SHIP) — a free service — to understand your options.

How to report your Medicare enrollment to Medicaid

After you enroll in Medicare, contact your state Medicaid office to report the change. You can usually do this by phone, online, or by mail. Have your Medicare card and Social Security number ready. Tell them your Medicare effective date and which parts you enrolled in (Part A, Part B, Part D, or a Medicare Advantage plan).

Your state will then review your case to see if you still meet the income and asset limits for people 65 and older. This review usually takes a few weeks. You will receive a notice in the mail telling you whether your Medicaid continues, ends, or changes. Keep this notice — it is your proof of your Medicaid status.

If you do not report your Medicare enrollment and your state finds out on its own, there may be a delay in updating your case, or you could lose coverage without warning. It is better to report it yourself and stay in control of the timeline.

State-by-state differences in Medicaid and Medicare coordination

Medicaid rules vary significantly by state. Some states have higher income limits for people 65 and older, which means more older adults can keep Medicaid. Other states have lower limits. Some states cover more services with Medicaid — like dental, vision, or hearing aids — while others cover very little beyond what Medicare already pays for.

A few states have expanded Medicaid to cover more working-age adults, and some of those people will move into the older-adult category at 65. If you live in an expansion state, you may have had Medicaid as a younger adult and keep it at 65 if your income is still below the older-adult limit.

To find your state's specific income limits and covered services, visit your state Medicaid office website or call the number on your Medicaid card. You can also call 1-800-MEDICARE and ask to speak with a counselor who can explain your state's rules.

Frequently Asked Questions

Do I have to enroll in Medicare Part B at 65, or can I stay on Medicaid only?

If you are may be able to access for Medicare, you should enroll in Part A (hospital insurance) at 65 because it is free and covers important services. Part B (medical insurance) has a monthly premium, but if you delay enrolling without a good reason, you may face a permanent penalty. If you are still working and have employer coverage, you may be able to delay Part B without penalty. Talk to Medicare or your employer's benefits office before you turn 65.

What if my income changes after I turn 65?

Report any income change to your state Medicaid office right away. If your income goes down, you may become newly may be able to access for Medicaid or for a program like QMB. If your income goes up and you lose Medicaid, you will receive a notice with an end date. Your Medicaid will end, but your Medicare continues.

Can I have Medicare Advantage and Medicaid at the same time?

Yes. If you enroll in a Medicare Advantage plan (Part C) instead of Original Medicare, you can still have Medicaid if you meet your state's income and asset limits. Medicaid will coordinate with your Medicare Advantage plan to cover costs the plan does not pay. Tell your state Medicaid office which plan you chose.

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

Medicaid rules are different in every state, so you will need to explore for Medicaid in your new state if you want to keep it. Your old state's Medicaid will end when you move. Contact your new state's Medicaid office to find out the income limits and how the process works. Your Medicare coverage moves with you and continues in any state.

Will I lose my Medicaid if I go into a nursing home?

No. If you need long-term care in a nursing home, Medicaid can help pay for it if you meet the income and asset limits. The rules for nursing home Medicaid are different — you may be allowed to keep more assets and income than you would for regular Medicaid — so contact your state Medicaid office to learn about long-term care coverage in your state.