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

You are not forced to choose one or the other. Medicare and Medicaid are separate programs run by different parts of the federal government, and they can work together to cover your medical costs. The combination is called dual coverage or being dually may be able to access.

Medicare is primarily for people 65 and older, regardless of income. Medicaid is for people with low income and limited assets, at any age. Because these rules overlap — a 67-year-old with low income fits both — many people hold both cards at the same time. When you have both, Medicare is your primary payer, meaning it pays first, and Medicaid covers costs Medicare does not pay.

The real question is not whether you can have both, but whether you meet the income and asset limits for Medicaid in your state, since Medicare has no income limit. Medicaid rules vary significantly by state, so what qualifies you in one state may not in another.

Key Takeaways

  • Medicare pays first when you have both programs; Medicaid covers the costs Medicare leaves behind, such as copayments and deductibles.
  • You must meet your state's Medicaid income and asset limits to hold both — Medicare has no income limit, but Medicaid does.
  • Income limits for Medicaid vary by state and range from roughly 74% to 100% of the federal poverty level, depending on your state's rules.
  • You can have both Original Medicare and Medicaid, or Medicare Advantage and Medicaid, but the coverage rules differ slightly between them.
  • Your state Medicaid office determines whether you are dually may be able to access; you do not need to contact Medicare separately to add Medicaid.

How Medicare and Medicaid work together when you have both

When you hold both programs, Medicare processes your claim first. It pays its share of the bill based on what it covers and what you have already paid toward your deductible. Then the bill goes to Medicaid, which pays some or all of what Medicare did not cover — typically your copayments, coinsurance, and deductibles.

This arrangement saves you money because you are not paying the full cost of Medicare's cost-sharing out of pocket. For example, if you see a doctor and Medicare covers 80% of the visit, you would normally owe 20%. With Medicaid, your state program may cover that 20% copay, leaving you with no bill.

Medicaid will not pay for services Medicare does not cover. If Medicare says a service is not medically necessary, Medicaid will not override that decision. However, Medicaid does cover some services Medicare does not — such as dental, vision, and hearing aids in many states — so you may have broader coverage than Medicare alone provides.

Income and asset limits for dual coverage by state

To hold Medicaid alongside Medicare, you must fall within your state's income and asset limits. These limits are not set by Medicare; they are set by each state's Medicaid program. Some states are more generous than others.

Most states use the federal poverty level as a benchmark. A state might set its Medicaid income limit at 74% of the federal poverty level, or 100%, or somewhere in between. For 2024, the federal poverty level for a single person is roughly $14,600 per year, though this changes annually. A state at 100% of poverty would allow a single person to earn up to about $14,600 and still may have access to for Medicaid. A state at 74% would set the limit at roughly $10,800.

Asset limits also vary by state. Some states have no asset limit for people over 65 on Medicaid. Others cap assets at $2,000 for a single person or $3,000 for a couple. Your home and one car are usually not counted as assets. You will need to check your specific state's rules, because the difference between states can be substantial.

To find your state's current income and asset limits, contact your state Medicaid office directly or visit your state's Medicaid website. The Centers for Medicare & Medicaid Services (CMS) maintains a list of state Medicaid offices on its website.

Original Medicare versus Medicare Advantage with Medicaid

You can have Medicaid paired with either Original Medicare (Parts A and B) or Medicare Advantage (Part C). The way they interact is slightly different.

With Original Medicare and Medicaid, Medicare pays first, and Medicaid covers the deductibles and copayments. You can see any doctor or hospital that accepts Medicare. Medicaid also covers services Original Medicare does not, such as dental or vision in many states.

With Medicare Advantage and Medicaid, the Medicare Advantage plan is your primary payer. Medicaid then covers costs the Advantage plan does not. However, some Medicare Advantage plans have network restrictions — you may be required to use in-network doctors. Medicaid will still cover out-of-network costs in many cases, but you should check both your Advantage plan and your state Medicaid program to understand how they coordinate.

If you are dually may be able to access, you may find that Original Medicare with Medicaid gives you more flexibility, because Original Medicare has no network restrictions. However, some states have programs specifically designed for people with Medicare Advantage and Medicaid, so compare your options before choosing a plan.

How to learn about you may have access to for Medicaid while on Medicare

Start by contacting your state Medicaid office. You can find the phone number and website through the CMS state Medicaid office directory, or by calling 211 (a free referral service). Tell them you are on Medicare and want to know if you meet the income and asset limits for Medicaid in your state.

Have the following information ready: your age, household size, monthly income (from Social Security, pensions, wages, or other sources), and approximate assets (savings, investments, property other than your home). The Medicaid office will tell you whether you likely may have access to based on these numbers.

If you appear to may have access to, the office will send you an process or direct you to explore online through your state's benefits portal. The process will ask for proof of income (recent pay stubs, Social Security statements, or tax returns), proof of assets (bank statements), and proof of citizenship or immigration status. Processing typically takes 30 to 45 days.

You do not need to contact Medicare to add Medicaid. Once your state approves you for Medicaid, the two programs automatically coordinate. Your Medicaid card will arrive by mail, and you will use both cards at medical appointments.

Common reasons people with Medicare do not may have access to for Medicaid

The most common reason is income. If your Social Security, pension, or other income exceeds your state's Medicaid limit, you will not may have access to, even if you are on Medicare. Some states have higher limits than others, but all have a ceiling.

Assets can also disqualify you. If you have savings, investments, or property (other than your primary home and one vehicle) that exceed your state's asset limit, you may not may have access to. Some people spend down assets intentionally to reach Medicaid may be able to access, but this is a complex decision that involves tax and legal considerations — consult a financial advisor or elder law attorney before doing so.

Immigration status matters in some cases. To may have access to for Medicaid, you must be a U.S. citizen or a may have access to immigrant. Undocumented immigrants are not may be able to access for standard Medicaid, though some states offer limited coverage for emergency services.

If you do not may have access to for full Medicaid, some states offer Medicare Savings Programs (MSPs) that help pay your Medicare premiums and cost-sharing without the strict income limits of Medicaid. These programs are worth exploring if you fall just above your state's Medicaid threshold.

What happens to your coverage if your income or assets change

Medicaid may be able to access is reviewed periodically — usually once a year, though some states review more frequently. If your income or assets increase above the limit, you may lose Medicaid coverage. If they decrease, you may become newly may be able to access or remain may be able to access.

Report changes to your state Medicaid office as soon as they happen. If you receive a raise, inherit money, or experience a major change in circumstances, contact Medicaid to update your information. Failing to report changes can result in overpayment that you may be asked to repay.

If you lose Medicaid because of an increase in income or assets, you will still have Medicare. You can then explore other cost-sharing options, such as a Medigap policy (supplemental insurance) or a Medicare Savings Program, depending on your new income level.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you meet your state's Medicaid income and asset limits, you can hold both at the same time. Medicare and Medicaid are designed to work together, with Medicare paying first and Medicaid covering costs Medicare does not.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not change what Medicare covers or how much Medicare pays. It only covers the costs Medicare leaves behind, such as copayments and deductibles. Your Medicare benefits remain the same.

What if my state has very strict Medicaid income limits?

If your income is too high for Medicaid but you struggle with Medicare costs, ask your state Medicaid office about Medicare Savings Programs. These programs help pay your Medicare premiums and cost-sharing and have higher income limits than full Medicaid in most states.

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

Yes, but coordination between the two can be complex. Some Medicare Advantage plans work better with Medicaid than others. If you are dually may be able to access and considering an Advantage plan, check with both the plan and your state Medicaid office to understand how they will work together.

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

Contact your state Medicaid office with your age, household size, monthly income, and approximate assets. They will tell you whether you meet the income and asset limits for your state. You can also call 211 for a referral to your local Medicaid office.