Yes, you can have both Medicaid and Medicare at the same time

Many people over 65 are enrolled in both programs simultaneously. 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. They serve different purposes and can work together to cover costs Medicare alone does not pay. The combination is sometimes called "dual coverage" or being "dually may be able to access."

Having both programs means Medicare pays first for covered services, and Medicaid can help pay some of the costs Medicare does not cover — like copayments, coinsurance, and deductibles. This arrangement can significantly reduce your out-of-pocket medical expenses, but the way the two programs coordinate depends on your state and your specific situation.

Key Takeaways

  • You can hold both Medicare and Medicaid if you meet the income and asset limits set by your state, even though you are already on Medicare.
  • Medicare pays first for covered services, and Medicaid steps in to help pay your share of the cost — copayments, coinsurance, and deductibles.
  • Income and asset limits for Medicaid vary by state, so you may be may be able to access in one state but not another.
  • Some states offer programs specifically designed for people with both Medicare and Medicaid, which may include additional services like dental or vision care.
  • You do not need to do anything special to coordinate the two programs — your providers handle the billing order automatically.

Who can have both Medicare and Medicaid

To have both programs, you must first be enrolled in Medicare (usually at age 65, or earlier if you receive Social Security Disability Insurance). You then must meet your state's Medicaid income and asset limits. These limits vary significantly by state — some states set the income limit at 100% of the federal poverty level, while others allow higher incomes. Your state's Medicaid program determines whether you may have access to based on where you live.

You do not have to be retired or unemployed to have both. Some working people over 65 have Medicare and also meet their state's Medicaid income threshold. Others become may be able to access for Medicaid after retirement when their income drops. The key is that your income and countable assets fall within your state's limits at the time you explore.

If you are under 65 and receive Medicare because of a disability, you can also have Medicaid if you meet your state's income and asset rules. The same coordination of benefits applies — Medicare pays first, and Medicaid covers some of your remaining costs.

How Medicare and Medicaid work together

When you have both programs, the billing order is fixed: Medicare always pays first for any service it covers. After Medicare pays its share, the claim goes to Medicaid. Medicaid then decides whether to pay some or all of the remaining balance, depending on your state's rules and the type of service.

For example, if you see your doctor and the visit costs $100, Medicare might pay $80 (after you meet your deductible). You would normally owe the remaining $20 as coinsurance. If you have Medicaid, it may pay that $20, leaving you with no out-of-pocket cost. However, Medicaid does not always pay the full remaining balance — it depends on what your state's program covers and how much it reimburses for that service.

Your providers do not need you to do anything to make this work. When you give them your Medicare card and Medicaid card, their billing staff submits the claim to Medicare first, waits for Medicare's decision, and then submits the remainder to Medicaid. This happens automatically in most cases.

What Medicaid covers that Medicare does not

Medicare has significant gaps in coverage. It does not cover routine dental care, eyeglasses, hearing aids, or long-term custodial care in a nursing home. Medicaid in most states does cover some of these services, though the scope varies widely. Some states cover dental cleanings and basic care; others cover only emergency dental treatment. Vision coverage, hearing aids, and other services differ by state as well.

One of the most important differences is long-term care. If you need to live in a nursing home for an extended period, Medicare covers only the first 100 days under specific conditions. After that, you pay out of pocket until your assets are depleted. Medicaid then covers nursing home care for people who meet income and asset limits. Having Medicaid while you still have assets can protect you by covering costs Medicare will not pay.

Medicaid also covers some prescription drugs that Medicare Part D does not, though both programs have formularies (lists of covered drugs) that change yearly. If you have both, Medicaid is usually the secondary payer for drugs, meaning Medicare Part D pays first.

Income and asset limits by state

Each state sets its own Medicaid income and asset limits for people over 65. There is no single national threshold. Some states use the "300% rule," allowing people with income up to 300% of the federal poverty level to have Medicaid; others use 100% or 150%. Your state's limit determines whether you can have both programs.

Asset limits also vary. Some states count your savings, investments, and property toward an asset limit (often around $2,000 for an individual, though this varies). Other states have eliminated asset limits entirely for seniors. Your home and one vehicle are typically not counted as assets, but the rules differ by state.

To find your state's specific limits, contact your state Medicaid office or call 211 (a free helpline that connects you to local resources). You can also visit your state's Medicaid website, which usually lists current income and asset thresholds. Because these limits change, it is worth checking every year, especially if your income or assets have shifted.

Special programs for people with Medicare and Medicaid

Some states offer programs specifically designed for people with both Medicare and Medicaid. These programs may provide additional services, care coordination, or lower out-of-pocket costs. Names and benefits vary by state — some call them "dual may be able to access programs," "integrated care programs," or "managed long-term care programs."

A few states have programs that combine Medicare and Medicaid into a single managed care plan, so you have one card and one set of providers instead of juggling two separate programs. These programs often include services like dental, vision, or transportation that neither Medicare nor Medicaid alone would cover. However, not all states offer these options, and enrollment may be automatic or voluntary depending on where you live.

Ask your state Medicaid office or your local Area Agency on Aging whether your state has a special program for people with both Medicare and Medicaid. If one exists and you are may be able to access, it may simplify your coverage and reduce your costs.

how the process works for Medicaid if you have Medicare

You explore for Medicaid through your state Medicaid office, not through Medicare or Social Security. Each state has its own process process, though most now allow you to explore online, by mail, or in person. Start by visiting your state's Medicaid website or calling your state Medicaid office to learn how the process works in your state.

You will need to provide proof of income (recent pay stubs, tax returns, or Social Security statements), proof of assets (bank statements, investment statements), proof of citizenship or legal residency, and proof of your Medicare enrollment. Have these documents ready before you start the process. The process usually takes 30 to 45 days, though it can be faster in some states.

If you are already receiving Supplemental Security Income (SSI) or other need-based benefits, you may be automatically enrolled in Medicaid in your state — you do not need to explore separately. Check with your state Medicaid office to confirm your status.

Frequently Asked Questions

If I have Medicaid, do I still need to pay my Medicare premiums?

Yes, you still pay your Medicare Part B premium (currently around $165 per month, though it varies by income). In many states, Medicaid will pay this premium for you if you meet income limits. Some states also pay your Part D (prescription drug) premium. Ask your state Medicaid office whether it covers Medicare premiums in your situation.

Can I lose Medicaid if my income goes up slightly?

Yes, if your income rises above your state's Medicaid limit, you may lose Medicaid coverage. However, many states have "spend-down" rules that allow you to deduct medical expenses from your income to stay under the limit. Some states also have protections that let you keep Medicaid for a few months even if your income temporarily exceeds the limit. Contact your state Medicaid office to understand how income changes affect your coverage.

What happens to my Medicaid if I move to a different state?

Medicaid is state-based, so your coverage ends when you move. You must explore for Medicaid in your new state, which has its own income and asset limits. You may be may be able to access in your new state even if you were not may be able to access in your old one, or vice versa. explore as soon as you move to avoid a gap in coverage.

Do I have to choose between Medicare Advantage and Medicaid?

No, you can have both a Medicare Advantage plan and Medicaid at the same time. However, some Medicare Advantage plans are designed specifically for people with both Medicare and Medicaid and may offer better coverage or lower costs. Ask your plan whether it is optimized for dual-may be able to access people, and compare it with other options available in your area.

Will having Medicaid affect my Medicare benefits?

No, Medicaid does not change what Medicare covers or how much Medicare pays. Medicaid straightforward helps pay some of the costs Medicare does not cover. Your Medicare benefits remain the same whether or not you have Medicaid.