Yes, you can have both Medicare and Medicaid, and many people do
You are not forced to choose between them. Medicare and Medicaid are separate programs that work together. Medicare is federal health insurance based on age or disability. Medicaid is a joint federal and state program based on income and assets. If you meet the rules for both, you can be enrolled in both at the same time. People with both are called dual may be able to access or dually may be able to access.
Having both programs means Medicaid often covers costs that Medicare does not — like long-term care, dental work, and vision care. Medicare pays first for the services it covers, and Medicaid fills in gaps. This can lower your out-of-pocket costs significantly.
Key Takeaways
- You can have Medicare and Medicaid at the same time if you meet income and asset limits set by your state.
- Medicare pays first for covered services, then Medicaid covers what Medicare does not pay.
- Medicaid covers many services Medicare does not, including long-term care, dental, and vision care.
- Each state sets its own Medicaid income and asset limits, so what qualifies in one state may not in another.
- You do not have to do anything special to coordinate the two programs — they communicate automatically once you are enrolled in both.
How income and asset limits work for dual coverage
To have Medicaid while on Medicare, your income and assets must fall below your state's limits. These limits vary widely by state. Some states use the federal poverty level as a starting point, while others set their own thresholds. A few states have no asset limit at all for certain Medicaid programs.
Your income includes Social Security, pensions, wages, and other regular payments. Your assets include bank accounts, investments, and property you own (though your home and one car usually do not count). If you are married, your spouse's income and assets may be counted differently depending on your state and the type of Medicaid program.
Because limits differ by state, you need to check with your state Medicaid office or use your state's online tool to see whether your income and assets may have access to. The Medicaid.gov website has a state-by-state directory with contact information and links to each state's rules.
Which Medicaid programs accept people with Medicare
Not all Medicaid programs are open to people already on Medicare. The most common path for dual coverage is through Medicaid for the Aged, Blind, and Disabled — a program specifically designed for people 65 and older or those on Medicare due to disability. This program exists in every state.
Some states also offer Medicaid Buy-In programs for working people with disabilities who are on Medicare. These let you keep working and stay on Medicaid even if your earnings would normally disqualify you. Rules vary by state.
A third option is may have access to Medicare Beneficiary (QMB) coverage, which pays your Medicare premiums and cost-sharing (copays and deductibles). You do not need to be on full Medicaid to may have access to for QMB — it is a smaller, more targeted program with higher income limits than full Medicaid in many states.
What Medicaid covers that Medicare does not
Medicare covers hospital stays, doctor visits, and some preventive care, but it has significant gaps. Medicaid fills many of those gaps for people who may have access to for both programs.
Medicaid covers long-term care — nursing home stays and in-home care — which Medicare covers only briefly after a hospital stay. This is one of the biggest reasons dual coverage matters. Medicaid also covers dental care, vision care (including eyeglasses), and hearing aids in most states, none of which Medicare covers. Medicaid pays for transportation to medical appointments in many states, and covers prescription drugs through its own formulary (though you may also be on a Medicare drug plan).
The exact services vary by state. Your state Medicaid office can tell you what is covered where you live.
How the two programs coordinate payments
When you have both programs, Medicare is the primary payer. This means Medicare processes your claim first and pays its share. Medicaid then receives the claim and pays what Medicare did not cover, up to what Medicaid allows.
You do not have to file claims with both programs separately. Once both programs know you are enrolled, they share information automatically. Your provider submits the claim to Medicare first. Medicare sends its payment and a record of what it paid to Medicaid. Medicaid then pays its portion directly to the provider or to you, depending on the service.
Because of this coordination, your out-of-pocket costs are usually much lower than if you had Medicare alone. Medicaid often covers Medicare's copays and deductibles, which can add up quickly.
How to learn about you may have access to in your state
Start by contacting your state Medicaid office. You can find the phone number and website through Medicaid.gov — select your state from the map, and you will see contact details and a link to your state's process process.
Many states also have online income and asset calculators. These give you a rough idea of whether you might may have access to before you explore. Some states let you start the process online; others require a phone call or in-person visit.
Bring documents showing your income (Social Security statements, pension letters, recent pay stubs), your assets (bank statements, investment statements), and proof of citizenship or legal residency. The exact documents your state needs are listed on its Medicaid website.
If you are already on Medicare, the process is usually faster because your age or disability status is already verified. Your state may be able to cross-check your information with Social Security automatically.
What happens if your income or assets change
If your income or assets increase above your state's limit, you may lose Medicaid coverage. You are required to report changes — the timeline varies by state, but most ask you to report within 10 to 30 days. Failing to report can result in overpayment that you may have to repay.
If your income drops, you may become newly may be able to access for Medicaid or move into a different Medicaid program with better benefits. Report income changes to your state Medicaid office as soon as they happen.
Your Medicare coverage does not change based on income or assets, so you will keep Medicare regardless of what happens with Medicaid.
Frequently Asked Questions
Do I have to choose between Medicare and Medicaid?
No. If you meet your state's income and asset limits, you can have both at the same time. Having both usually costs you less out of pocket than having Medicare alone, because Medicaid covers many services and costs that Medicare does not.
Will having Medicaid affect my Medicare benefits?
No. Medicare benefits do not change based on whether you also have Medicaid. Medicaid straightforward fills in gaps and covers additional services. The two programs work together without affecting each other.
What if I live in a state that did not expand Medicaid?
Even in states that did not expand Medicaid for working-age adults, Medicaid for the Aged, Blind, and Disabled is available. This program is federally required and exists in every state. Your income and asset limits may be lower than in expansion states, but the program is there.
Can I have Medicare Advantage and Medicaid at the same time?
Yes. If you are on a Medicare Advantage plan and may have access to for Medicaid, you can have both. Medicaid will coordinate with your Advantage plan the same way it does with Original Medicare. Some states have special programs designed specifically for people with both Advantage plans and Medicaid.
How long does it take to get Medicaid if I already have Medicare?
Processing time varies by state, but typically ranges from two to four weeks. Because your age or disability is already verified through Medicare, the process is often faster than for people explore to Medicaid for the first time. Some states can approve you within days if you explore online.