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

If you are 65 or older, or younger and disabled or on dialysis, you may have Medicare. If your income and assets fall below your state's limits, you may also have Medicaid. When you have both, you are called dual may be able to access. Medicare is your primary insurance — it pays first — and Medicaid fills in gaps like copays, deductibles, and services Medicare does not cover.

The two programs work together, not against each other. You do not have to choose one. In fact, having both often costs you less out of pocket than having Medicare alone, because Medicaid covers expenses Medicare leaves behind. Your state Medicaid program handles the coordination, and you keep both cards.

Key Takeaways

  • You can hold both Medicare and Medicaid at the same time if you meet income and asset limits set by your state.
  • Medicare pays first for covered services, and Medicaid then covers your share of the cost — copays, coinsurance, and deductibles.
  • Medicaid also covers long-term care services like nursing home stays and home care, which Medicare does not.
  • Your state determines Medicaid income limits, which vary widely; some states cover people earning up to 138% of the federal poverty level, others much lower.
  • You do not need to do anything special to coordinate the two — your providers and insurers handle it once both are active.

Income and asset limits for dual coverage

To hold both Medicare and Medicaid, you must meet your state's Medicaid income and asset thresholds. Income limits vary by state and by whether you are single or married. Some states use the federal poverty level as a baseline; others set their own. For 2024, the federal poverty level for a single person is roughly $15,000 per year, but many states allow higher income — up to 138% of poverty or more — especially if you are over 65.

Asset limits also vary by state. Most states allow you to own a home without counting it toward your limit, and a car. Savings, investments, and other property do count. Some states set the limit at $2,000 for a single person; others at $3,000 or higher. Your state Medicaid office can tell you the exact thresholds that explore to you.

If your income or assets exceed the limit, you may still be able to use a spend-down strategy — paying for medical care or other allowed expenses to bring your assets below the threshold — but this requires planning and state approval. Talk to your state Medicaid office or a benefits counselor before spending down on your own.

What Medicaid covers that Medicare does not

Medicare covers hospital stays, doctor visits, and some outpatient services. It does not cover long-term care in a nursing home, assisted living, or ongoing home care. Medicaid does. This is one of the biggest reasons dual-may be able to access people keep both: Medicaid pays for months or years in a nursing facility if you need it, while Medicare covers only up to 100 days after a hospital stay.

Medicaid also covers dental care, vision care, and hearing aids in most states — services Medicare does not. It covers transportation to medical appointments, which Medicare does not. It may cover prescription drugs not on Medicare's formulary. And it covers cost-sharing: when Medicare says you owe a copay or coinsurance, Medicaid often pays your share.

The exact services vary by state. Your state Medicaid program publishes a list of covered services; you can find it through your state health department or by calling your local Medicaid office.

How Medicare and Medicaid coordinate payment

When you have both, Medicare always pays first for services it covers. If Medicare covers a doctor visit and says you owe a $20 copay, Medicaid then pays that copay. If Medicare covers a hospital stay and you owe coinsurance, Medicaid covers it. This is called coordination of benefits.

Your providers do not need you to do anything special. Once both programs know you have both insurance, they send claims to Medicare first, then to Medicaid. The process is automatic. You should carry both your Medicare card and your Medicaid card, and show both when you go to a doctor or hospital.

If a service is covered by Medicaid but not Medicare — like a nursing home stay — Medicaid pays the full cost (up to what it allows). You do not pay anything unless your state requires a small patient contribution, which some do.

How to learn about you are dual may be able to access

If you already have Medicare and think you may also be may be able to access for Medicaid, contact your state Medicaid office. You can find it by searching "[your state] Medicaid" or by calling 211 (a free helpline that connects you to local benefits programs). You can also visit your state health department website.

When you call, have ready: your Social Security number, proof of income (recent pay stubs, tax return, or bank statements), proof of assets (bank account statements, investment statements), and proof of citizenship or immigration status. The office will tell you whether you meet the income and asset limits for your state.

If you are already on Medicaid and turn 65, you automatically become dual may be able to access once Medicare starts. You do not need to reapply to Medicaid. If you are on Medicare and your income drops — because you retired, or a spouse died, or you lost a job — you may become newly may be able to access for Medicaid. Contact your state office to report the change.

What happens to your Medicare coverage when you add Medicaid

Your Medicare coverage does not change. You keep your Medicare Part A (hospital insurance) and Part B (doctor and outpatient services). If you are in a Medicare Advantage plan (Part C), some states require you to switch to Original Medicare (Part A and B) when you become dual may be able to access, because Medicaid needs to coordinate with Original Medicare more easily. Check with your state Medicaid office about this rule in your state.

Your Part D prescription drug coverage may change. If you are in a standalone Part D plan, Medicaid may take over as your primary drug insurer once you are dual may be able to access. Some states require this; others do not. Your state Medicaid office will tell you what to expect.

You will receive separate bills and explanations of benefits from Medicare and Medicaid. Keep both. If you see a charge you do not recognize, contact the program that sent the bill.

Common mistakes to avoid

Do not assume you are ineligible because your income seems too high. Income limits are higher than many people think, especially for people over 65. Call your state office to check.

Do not delay reporting a change in income or assets. If your situation changes — you inherit money, you start receiving a pension, a spouse dies — tell your state Medicaid office within 30 days. Failing to report can result in overpayment, which the state may ask you to repay.

Do not ignore bills from either program. If Medicare or Medicaid denies a claim, you have the right to appeal. Contact the program that denied it and ask for an appeal form. Many people win on appeal.

Do not assume your provider accepts both. Some doctors and hospitals do not accept Medicaid, even if they accept Medicare. Call ahead to confirm before your appointment.

Frequently Asked Questions

What is the income limit for dual Medicare and Medicaid?

It depends on your state. Most states allow income up to 100% to 138% of the federal poverty level for people over 65, but some allow higher. Call your state Medicaid office or 211 to learn your state's exact limit.

If I am on Medicare Advantage, do I have to switch to Original Medicare when I get Medicaid?

Some states require it; others do not. Contact your state Medicaid office to find out. If you must switch, the state will help you move to Original Medicare and enroll in a Part D plan.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not reduce or change your Medicare coverage. It only fills in costs Medicare does not cover, like copays and long-term care.

Can I lose Medicaid if my income goes up slightly?

Yes, if your income exceeds your state's limit. But many states have a grace period or allow small increases without when ready ending coverage. Report any income change to your state office right away so they can tell you what happens.

Do I need to pay premiums for Medicaid if I am dual may be able to access?

Most states do not charge premiums for Medicaid to people over 65 who are dual may be able to access. Some charge small copays for certain services. Your state Medicaid office will tell you what you owe.