Yes, you can have both Medicaid and Medicare

You can hold both programs at once. In fact, millions of people do. Medicare is a federal health insurance program based on age or disability. Medicaid is a joint federal and state program based on income and assets. The two programs have different rules, different coverage, and different costs — so having both means you get the benefits of each, and each program pays its share of your medical bills.

People with both programs are called dual may be able to access. The combination usually happens in one of three ways: you turn 65 and become may be able to access for Medicare while still meeting your state's Medicaid income limits; you become disabled and may have access to for Medicare, and your income is low enough for Medicaid; or you had Medicaid before retirement and keep it after you turn 65 and enroll in Medicare.

The main advantage is that Medicaid covers costs Medicare does not — like long-term care, dental, vision, and hearing aids in most states. The main complexity is that both programs have to coordinate their payments, and the rules differ by state.

Key Takeaways

  • Dual may be able to access means you have both Medicare and Medicaid, and each program pays its share of covered medical costs.
  • Medicaid covers services Medicare does not, including long-term care, dental, vision, and hearing aids in most states.
  • Your state determines Medicaid income and asset limits, so whether you can keep Medicaid after turning 65 depends on where you live.
  • You must enroll in Medicare Part A and Part B to be dual may be able to access; Medicaid does not enroll you automatically.
  • Some states offer special Medicare Savings Programs that help pay your Medicare premiums and cost-sharing if your income is very low.

How Medicare and Medicaid coordinate payments

When you have both programs, Medicare is the primary payer for services it covers. That means Medicare pays first, up to what it owes. Medicaid then pays what Medicare did not cover — your deductibles, copayments, and coinsurance — as long as Medicaid covers that service in your state.

This matters because it changes what you actually pay out of pocket. For example, Medicare Part B has a yearly deductible and then 20% coinsurance for doctor visits. If you have Medicaid, Medicaid typically covers that 20% coinsurance, so your cost drops to zero. The same applies to hospital stays: Medicare covers most of the cost after your deductible, and Medicaid covers the rest.

However, Medicaid does not cover everything Medicare does not. Each state decides which services Medicaid will pay for. Some states cover dental and vision; others do not. Some cover hearing aids; others do not. You need to know what your state's Medicaid program covers to understand your actual out-of-pocket costs.

Income and asset limits for dual may be able to access status

To be dual may be able to access, you must meet both Medicare and Medicaid rules. Medicare has no income limit — anyone 65 or older, or disabled for two years, can enroll. Medicaid does have income and asset limits, and they vary by state.

Most states use the federal poverty level as a starting point. In 2024, the federal poverty level for a single person is roughly $15,000 per year, though states can set their own limits higher. Some states allow income up to 100% of the federal poverty level; others allow up to 150% or 200%. A few states have no income limit at all for seniors already on Medicaid.

Asset limits also vary. Some states allow you to keep up to $2,000 in countable assets (not including your home or car); others allow more. Countable assets typically include bank accounts, stocks, and bonds, but not your primary residence or one vehicle. If you are over the asset limit, you may lose Medicaid even if your income qualifies.

The safest approach is to contact your state Medicaid office or use your state's online tool to check your current income and assets against the limits. Rules change, and your state's website will have the current thresholds.

Enrolling in Medicare if you already have Medicaid

If you have Medicaid and turn 65, you must enroll in Medicare Part A and Part B yourself. Medicaid does not do this for you, and Medicare does not happen automatically. You have a seven-month window centered on your 65th birthday — three months before, the month of, and three months after — to enroll without a penalty.

To enroll, visit Medicare.gov, call 1-800-MEDICARE, or go to your local Social Security office. You will need your Social Security number and proof of citizenship or legal residency. Enrollment takes about 15 minutes online or by phone.

After you enroll in Medicare Part A and Part B, tell your state Medicaid office that you now have Medicare. Medicaid will update your account to coordinate with Medicare. Some states do this automatically if they share data with Social Security; others require you to report it. Check with your state Medicaid office to confirm they know you have Medicare.

Medicare Savings Programs for people with very low income

If you are dual may be able to access and your income is very low — typically below 135% to 200% of the federal poverty level, depending on your state — you may also may have access to for a Medicare Savings Program. These programs help pay your Medicare Part B premium, and sometimes your Part A premium, deductibles, and coinsurance.

There are three main programs: the may have access to Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the may have access to Individual (QI) program. Each has different income limits and covers different costs. QMB is the most generous; it covers Part A and Part B premiums plus cost-sharing. SLMB covers Part B premiums only. QI covers Part B premiums only and has the highest income limit.

To find out which program you might may have access to for, contact your state Medicaid office or call 1-800-MEDICARE. You do not need to enroll separately; your state Medicaid office handles it. If you may have access to, the program pays the premium or cost-sharing directly to Medicare or your provider.

What happens to Medicaid when you turn 65 and get Medicare

Turning 65 and enrolling in Medicare does not automatically end your Medicaid. Whether you keep Medicaid depends on your income and assets and your state's rules.

In most states, if your income stays below the Medicaid limit after you turn 65, you keep Medicaid. Your Medicaid coverage continues, and it now coordinates with Medicare. However, some states have different income limits for working-age adults and seniors, so your income might have may have access to you for Medicaid before 65 but not after. Check with your state Medicaid office before you turn 65 to understand whether your coverage will continue.

If you lose Medicaid because your income is now too high, you may still may have access to for a Medicare Savings Program if your income is low enough. That program can help pay your Medicare premiums and cost-sharing, which is a partial substitute for Medicaid coverage.

Managed care plans for dual may be able to access people

Some states offer special managed care plans designed for people who are dual may be able to access. These plans coordinate Medicare and Medicaid benefits in one plan, so you have one insurance card, one set of doctors, and one deductible instead of managing two separate programs.

These plans are called D-SNPs (Dual may be able to access Special Needs Plans) or integrated plans. They are optional — you can stay in Original Medicare and Medicaid instead — but many people find them simpler because everything is in one place.

However, D-SNPs are not available in every state, and not every plan is available in every county. If you are interested, ask your state Medicaid office or visit Medicare.gov to see which plans are available where you live. Open enrollment for these plans runs from October 15 to December 7 each year, with coverage starting January 1.

Common mistakes to avoid

The biggest mistake is not enrolling in Medicare when you turn 65. If you delay past your seven-month enrollment window, you will face a permanent penalty on your Part B premium — 10% extra for each year you were late. Medicaid cannot protect you from this penalty, so enroll on time even if you think Medicaid covers everything.

Another mistake is not telling Medicaid that you enrolled in Medicare. If Medicaid does not know you have Medicare, it may not coordinate payments correctly, and you could end up paying more than you should. After you enroll in Medicare, contact your state Medicaid office to update your account.

A third mistake is assuming Medicaid covers everything Medicare does not. Each state's Medicaid program is different. Some cover dental and vision; others do not. Some cover hearing aids; others do not. Read your state's Medicaid handbook or call your state Medicaid office to find out exactly what is covered.

Finally, do not ignore asset limits. If you have savings or investments that push you over your state's Medicaid asset limit, you will lose Medicaid even if your income qualifies. Some people work with an elder law attorney to plan their assets before they turn 65, so they can stay under the limit and keep Medicaid. This is legal and common.

Frequently Asked Questions

Do I have to enroll in Medicare Part D if I have Medicaid?

No. Medicaid covers prescription drugs in most states, so you do not need Part D. However, if you drop Medicaid later, you will face a penalty if you did not enroll in Part D when you were first may be able to access. If you think you might lose Medicaid, it is safer to enroll in Part D even if you do not use it.

What if my state did not expand Medicaid?

If your state did not expand Medicaid under the Affordable Care Act, the income limits for Medicaid are lower, and you may not may have access to even if your income is modest. In those states, you would have Medicare only, not dual may be able to access status. Check your state's Medicaid website to see the current income limits.

Can I switch from Original Medicare to a D-SNP plan if I have Medicaid?

Yes. D-SNP plans are open to people who are dual may be able to access. You can switch during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event, like losing Medicaid. Call the plan directly or visit Medicare.gov to see which D-SNPs are available in your area.

What if I move to a different state?

Medicaid rules vary by state, so moving may change your coverage. You may lose Medicaid in the new state if the income or asset limits are lower, or you may gain coverage if the limits are higher. Contact your new state's Medicaid office as soon as you move to understand how your coverage changes. Medicare coverage stays the same nationwide.

Do I need to pay Medicaid premiums if I have Medicare?

Most people who are dual may be able to access do not pay a Medicaid premium. However, some states charge a small premium for certain Medicaid services. Check with your state Medicaid office to see if you owe any premiums. If you may have access to for a Medicare Savings Program, that program may also help pay any Medicaid cost-sharing.