Yes, you can have both Medicare and Medicaid, and many people do

You are not limited to one program. If you meet the income and asset requirements for Medicaid in your state, you can hold both Medicare and Medicaid at the same time. When you have both, Medicare is your primary insurance — it pays first — and Medicaid covers some of what Medicare does not, including copayments, coinsurance, and deductibles. People with both programs are sometimes called "dual may be able to access" or "dually may be able to access."

Having both programs can significantly reduce your out-of-pocket costs. Medicare alone leaves gaps: it does not cover long-term care, dental, vision, or hearing. Medicaid fills many of those gaps. The combination means you may pay little or nothing when you see a doctor, fill a prescription, or go to the hospital.

Key Takeaways

  • You can have Medicare and Medicaid at the same time if your income and assets fall below your state's Medicaid limits.
  • Medicare pays first for covered services, and Medicaid then covers your Medicare copayments, coinsurance, and deductibles.
  • Medicaid covers services Medicare does not, such as long-term care, dental care, and vision care, depending on your state.
  • Each state sets its own Medicaid income and asset limits, so may be able to access varies by where you live.
  • You do not need to choose between the programs — you can hold both and use them together.

How Medicare and Medicaid work together

When you have both programs, the order in which they pay matters. Medicare always pays first for any service it covers. Once Medicare has paid its share, Medicaid looks at what remains and may cover the rest. For example, if Medicare covers a doctor visit but charges you a $15 copayment, Medicaid can pay that copayment for you.

This arrangement is called "coordination of benefits." Providers send the claim to Medicare first. Medicare processes it and sends an explanation of benefits to you and to Medicaid. Medicaid then receives that information and decides whether to pay the remaining balance. The whole process usually takes a few weeks.

In some cases, Medicaid will pay Medicare premiums, deductibles, and copayments on your behalf. This happens automatically once both programs know you have both. You do not need to ask or submit separate paperwork for each claim.

Income and asset limits vary by state

Medicaid is a state program, so each state sets its own rules for who can have it. Income limits range widely — some states allow people earning up to 100 percent of the federal poverty level, while others go higher. Asset limits also differ: some states allow you to own up to $2,000 in countable assets (not counting your home or car), while others have higher or lower thresholds.

To find your state's current limits, contact your state Medicaid office directly or visit your state health department website. You can also call 211 and ask for a referral to your local Medicaid office. They can tell you whether your income and assets fall within the range and what documents you will need to provide.

If your income is slightly above the limit, you may still be able to have Medicaid through a "spend-down" process. This means you can deduct certain medical expenses from your income to bring it below the threshold. Ask your state Medicaid office whether your situation qualifies.

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 them. Long-term care — nursing home stays, assisted living, or in-home care — is one of the biggest gaps Medicare leaves. Medicaid pays for long-term care if you meet income and asset limits, though rules vary by state and type of care.

Medicaid also covers dental care, vision care (including eyeglasses), and hearing aids in most states, though the scope and limits vary. Some states cover all three; others cover only one or two. Prescription drugs are covered by both programs, but Medicaid may cover drugs Medicare does not, depending on your state's formulary.

Transportation to medical appointments is another service Medicaid often covers when Medicare does not. If you cannot drive and have no other way to reach a doctor, Medicaid may pay for a ride. Mental health and substance use treatment coverage also varies by state but is often more generous under Medicaid than Medicare alone.

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 on your state health department website or by calling 211. Have your Social Security number, birth date, income information (recent pay stubs or tax return), and a list of your assets (bank accounts, investments) ready when you call.

Many states now allow you to check your likely status online before you call. Your state Medicaid website may have a pre-screening tool that asks basic questions about income and assets. This can give you a rough idea of whether you fall within the range, though it is not a final decision.

If you are already on Medicare, you do not need to do anything special to explore for Medicaid — you use the same process process as anyone else. Some states have simplified forms for people over 65. Ask whether your state offers a shorter process for seniors.

What happens after you are approved for both

Once you have both Medicare and Medicaid, you will receive a Medicaid card in addition to your Medicare card. Both cards are active at the same time. When you see a doctor or go to a hospital, show both cards. The provider's office will submit claims to both programs automatically.

Your Medicaid coverage may change if your income or assets increase. You are required to report changes — such as a raise, a new job, or receiving an inheritance — to your state Medicaid office. The rules about what counts as income and what counts as an asset are complex, so ask your caseworker which changes you must report.

You will receive a Medicaid renewal notice periodically (usually once a year, though some states renew more often). You must respond to this notice or your coverage will end. Keep your Medicaid office informed of any address changes so you do not miss a renewal notice.

Frequently Asked Questions

Do I have to pay for both Medicare and Medicaid?

Medicare requires a premium for Part B (doctor visits) and Part D (prescriptions) unless you are exempt. Most people with both Medicare and Medicaid have Medicaid pay these premiums for them. Medicaid itself has no premium — it is free once you are approved.

What if my income goes up after I am approved?

You must report income changes to your state Medicaid office. If your income rises above the limit, you may lose Medicaid coverage. However, some states have "income disregards" or allow you to set aside earnings, so ask whether your situation qualifies before assuming you will lose coverage.

Can I have both if I am still working?

Yes. Age 65 or older with low income and assets can have both, regardless of employment status. Some states have special programs for working people with disabilities that allow higher income limits. Contact your state Medicaid office to learn what applies to you.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not change what Medicare covers or how Medicare works. It only helps pay the costs Medicare leaves behind. Your Medicare benefits remain the same whether or not you have Medicaid.

What if I move to a different state?

Medicaid rules are different in every state, so your coverage may change when you move. Contact your new state's Medicaid office as soon as you arrive to learn about that state's income limits, covered services, and process process. Your old state's Medicaid will end when you establish residency in the new state.