Having Both Medicare and Medicaid at the Same Time

Yes, you can have both Medicare and Medicaid, and millions of people do

If you are 65 or older, or younger and disabled, you can hold both Medicare and Medicaid at the same time. People with both programs are called dual may be able to access. Medicare is federal health insurance; Medicaid is a joint federal and state program for people with low income or limited resources. They work together — Medicare covers some costs, Medicaid covers others, and together they reduce what you pay out of pocket.

The two programs do not compete. Instead, Medicaid often pays what Medicare does not cover: copayments, coinsurance, deductibles, and premiums. For people living on a fixed income, this combination can mean the difference between getting care and skipping it because of cost.

Key Takeaways

You can hold both Medicare and Medicaid if you meet income and resource limits set by your state, which vary by location.
Medicare pays first for covered services, then Medicaid covers the costs Medicare leaves behind — copays, deductibles, and premiums.
You must be 65 or older, or younger and disabled or blind, to be dual may be able to access.
Each state runs its own Medicaid program, so the income limit and covered services differ depending on where you live.
You enroll in Medicare through Social Security; you enroll in Medicaid through your state's Medicaid office or online portal.

Who can be dual may be able to access

To hold both programs, you must meet Medicare's rules and your state's Medicaid rules at the same time. For Medicare, you need to be 65 or older, or younger and receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), or have end-stage renal disease or ALS.

For Medicaid, the income and resource limits depend on your state. Most states use a threshold of around $1,000 to $2,000 in countable resources (savings, investments, property other than your home), but this varies. Your state's Medicaid office publishes its current limits on its website. Some states are more generous than others, and some have expanded Medicaid under the Affordable Care Act, which changes who can join.

If you are already on Medicare and your income drops or your circumstances change, you may become Medicaid-may be able to access. You do not have to wait for an annual enrollment period — you can join Medicaid any time you meet the rules.

How Medicare and Medicaid work together

When you have both programs, Medicare is the primary payer. This means Medicare pays its share of the cost first. Medicaid is the secondary payer and covers what Medicare does not. In practice, this means Medicaid often pays your Medicare premiums, deductibles, and copayments.

For example, if you see a doctor and Medicare covers 80 percent of the visit, you would normally owe 20 percent. If you have Medicaid, Medicaid typically pays that 20 percent. If you take a prescription drug covered by Medicare Part D, Medicare pays most of the cost, and Medicaid covers your copay. This layering of coverage is why dual may be able to access people often have lower out-of-pocket costs than people with Medicare alone.

Medicaid also covers some services Medicare does not, such as long-term care in a nursing home (if you meet the medical need and income rules), dental care, and vision care. The exact services vary by state. Check your state's Medicaid handbook or call your state Medicaid office to see what is covered where you live.

Income and resource limits by state

Medicaid income limits for people 65 and older vary widely. Some states use the federal poverty level (around $1,500 per month for an individual in 2024, though this changes yearly), while others allow higher income. A few states have no income limit at all for people over 65 — they look only at resources.

Resources include bank accounts, stocks, bonds, and real estate other than your primary home. Your car is usually not counted. Most states allow $2,000 in resources for an individual and $3,000 for a couple, but some allow more. A few states count resources differently or have higher limits.

Because limits vary so much, the only way to know whether you may have access to in your state is to contact your state Medicaid office directly or use your state's online screening tool. You can find your state Medicaid office through the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE.

How to enroll in both programs

You enroll in Medicare and Medicaid through separate processes. For Medicare, you enroll through Social Security — either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. If you are already receiving Social Security benefits, you are automatically enrolled in Medicare Part A and Part B when you turn 65.

For Medicaid, you explore through your state. Most states now have online portals where you can start an process. You can also explore by mail, phone, or in person at your local Medicaid office. Your state Medicaid office website lists all the ways to explore and what documents you will need — usually proof of income, proof of resources, proof of citizenship, and proof of residency.

If you are already on Medicare and become Medicaid-may be able to access later, you can explore to Medicaid at any time. You do not have to wait for Medicare's annual enrollment period. Medicaid will process your process and let you know if you are approved and when coverage begins.

Costs when you have both programs

Your costs depend on which services you use and how your state's Medicaid program works. If you have both Medicare and Medicaid, you typically pay little or nothing for Medicare-covered services because Medicaid covers your cost-sharing. You may have small copayments for some Medicaid services, but these are usually lower than what you would pay with Medicare alone.

You still pay Medicare Part B premiums (currently $164.90 per month for most people in 2024, though this changes yearly), but Medicaid covers this premium for you. You do not pay it out of your own pocket. If you enroll in a Medicare Advantage plan or Part D prescription drug coverage, Medicaid may cover those premiums too, depending on your state.

Long-term care in a nursing home is where costs matter most. If you need a nursing home and have Medicaid, Medicaid covers the cost after you spend down your resources to the Medicaid limit (usually around $2,000). Medicare covers only the first 100 days of skilled nursing care after a hospital stay, and only if specific conditions are met. After that, Medicaid takes over if you may have access to.

Special Medicare Advantage plans for dual may be able to access people

Some Medicare Advantage plans are designed specifically for people with both Medicare and Medicaid. These are called Dual may be able to access Special Needs Plans (D-SNPs). They coordinate benefits between the two programs and often include extra services like dental, vision, or transportation that regular Medicare does not cover.

D-SNPs are not available in every state or every county, and not all insurance companies offer them. If one is available where you live, you can join during Medicare's annual enrollment period (October 15 to December 7 each year) or if you are newly dual may be able to access. Your state Medicaid office or 1-800-MEDICARE can tell you whether D-SNPs are available in your area.

Before joining a D-SNP, compare it to Original Medicare (Part A and Part B) plus a Medigap policy or Medicaid alone. Some people save money with a D-SNP; others do better with Original Medicare and Medicaid. The right choice depends on which doctors and hospitals you use, which drugs you take, and what services matter most to you.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you meet the rules for both, you can have both at the same time. You do not have to pick one or the other. In fact, having both usually costs you less than having either one alone.

What happens to my Medicaid if my income goes up?

If your income rises above your state's Medicaid limit, you may lose Medicaid coverage. However, you will keep Medicare. Some states have programs that let you keep Medicaid even if your income is slightly above the limit, especially if you are working. Contact your state Medicaid office to ask about work incentive programs.

Can I use any doctor with both Medicare and Medicaid?

Doctors who accept Medicare will see you. Most also accept Medicaid, but not all. When you call to make an appointment, ask whether the doctor takes both Medicare and Medicaid. If you join a Medicare Advantage plan, you may have to use doctors in that plan's network.

Does Medicaid pay for things Medicare does not cover?

Yes. Medicaid covers some services Medicare does not, such as long-term nursing home care, dental care, vision care, and hearing aids — though what is covered varies by state. Check your state's Medicaid handbook or call your state Medicaid office to see what is available where you live.

How do I know if I am dual may be able to access?

You are dual may be able to access if you are enrolled in both Medicare and Medicaid. You can check your Medicare status by logging into your account at Medicare.gov or calling 1-800-MEDICARE. To check your Medicaid status, contact your state Medicaid office or log into your state's online portal.

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.