Yes, you can have both Medicare and Medicaid, and millions of people do
You are not forced to choose one or the other. If you meet the income and asset limits for Medicaid in your state, you can hold both programs at the same time. People with both are called dual may be able to access or dually enrolled. Medicare covers hospital care, doctor visits, and some prescription drugs. Medicaid covers services Medicare does not — like long-term care, dental, vision, and hearing — and it also helps pay your Medicare premiums and out-of-pocket costs.
The main reason to pursue both is cost. Medicare has deductibles, copays, and gaps in coverage. Medicaid fills those gaps if your income is low enough. But the rules for having both vary significantly by state, and the process for getting Medicaid while on Medicare is different from the process for getting Medicaid alone.
Key Takeaways
- You can hold Medicare and Medicaid at the same time if your income and assets fall below your state's Medicaid limits.
- Medicaid covers costs Medicare does not pay for, including long-term care, dental, vision, and your Medicare premiums.
- Income limits for dual enrollment vary by state and change each year, so you must check your specific state's current thresholds.
- You explore for Medicaid through your state health department or social services office, not through Medicare or Social Security.
- Some states offer special Medicaid programs designed specifically for people already on Medicare, with higher income limits than regular Medicaid.
Income and asset limits for having both programs
Medicaid has strict income and asset limits, and they differ by state. To hold both Medicare and Medicaid, your income must fall below your state's threshold. For 2024, most states set the limit somewhere between 75% and 100% of the federal poverty level, though some states are higher. A single person's income limit might be around $1,100 to $1,500 per month, depending on where you live. These numbers change yearly, so the limit this year is not the limit next year.
Assets matter too. Most states allow you to own no more than $2,000 in countable assets if you are single, or $3,000 if you are married. Your home and one car do not count. Bank accounts, stocks, and other liquid assets do count. Some states have higher asset limits, and a few have none at all. You need to know your state's exact numbers before you explore, because being over the limit by even a small amount will disqualify you.
Your state Medicaid office publishes these limits every year. You can find them on your state health department website or by calling your local Medicaid office directly. Do not rely on a general number you find online — use your state's official figure.
How Medicaid helps when you already have Medicare
If you have both programs, Medicaid becomes your secondary payer. Medicare pays first for covered services, and Medicaid covers what Medicare does not. This means Medicaid pays your Medicare Part B premium (usually around $165 per month in 2024, though it varies by income), your Part A deductible, and your copays and coinsurance. For many people, this cuts their out-of-pocket costs to nearly zero.
Medicaid also covers services Medicare does not cover at all. Long-term care in a nursing home is the biggest one — Medicare covers only the first 100 days under strict conditions, but Medicaid covers indefinite stays if you meet the medical and financial criteria. Medicaid also pays for dental care, vision care, hearing aids, and some prescription drugs that Medicare does not. In some states, Medicaid covers transportation to medical appointments and personal care services like help with bathing and dressing.
The exact services Medicaid covers vary by state. Some states are more generous than others. Once you know you meet the income and asset limits, contact your state Medicaid office to learn what services are available to you.
Special Medicaid programs for people on Medicare
Several states run Medicaid programs designed specifically for people already enrolled in Medicare. These programs often have higher income limits than regular Medicaid, making it easier to may have access to if you are on a fixed income. The names vary by state — some call them "Medicare Savings Programs," others use different titles — but they all serve the same purpose: to help Medicare beneficiaries afford their premiums and cost-sharing.
The may have access to Medicare Beneficiary (QMB) program is one example. It pays your Medicare Part A and Part B premiums, deductibles, and copays if your income is below 100% of the federal poverty level. The Specified Low-Income Medicare Beneficiary (SLMB) program pays your Part B premium only if your income is between 100% and 120% of poverty. A third program, may have access to Individual (QI), helps with Part B premiums for people with income between 120% and 135% of poverty.
Not all states run all three programs, and income limits shift each year. Ask your state Medicaid office which programs exist in your state and whether you meet the income threshold for each one. These programs are separate from full Medicaid, so you can be in one of them without meeting full Medicaid's asset limits.
how the process works for Medicaid while on Medicare
You explore for Medicaid through your state, not through Medicare or Social Security. Contact your state Medicaid office, your county social services department, or your state health department — the exact agency depends on where you live. Many states now let you explore online through their Medicaid portal. You can also explore in person at a local office or by mail.
Bring or upload proof of income (recent pay stubs, Social Security statements, or pension letters), proof of assets (bank statements), proof of citizenship or legal residency, and proof of Medicare enrollment (your Medicare card). You will also need to list any medical conditions that require care. The office will tell you what documents they need before you submit anything.
Processing times vary. Some states decide in two to four weeks; others take six to eight weeks. You can ask about the timeline when you explore. If you are approved, Medicaid coverage usually starts on the first day of the month after approval, though some states backdate coverage to the month you applied.
What happens to your Medicare coverage when you get Medicaid
Your Medicare coverage does not change. You keep your Medicare card, your Medicare number, and all your Medicare benefits. You still see the same doctors and use the same hospitals. The only difference is that Medicaid now helps pay the costs Medicare does not cover. You will receive a Medicaid card in addition to your Medicare card, and you should show both when you go to the doctor.
If you are in a Medicare Advantage plan (Part C), some states require you to switch to Original Medicare (Part A and Part B) when you become Medicaid-may be able to access. Other states allow you to stay in Advantage. Check with your state Medicaid office before you explore, because this can affect which doctors you can see. If you must switch, your state will help you do it.
Your prescription drug coverage may also change. If you are in a Medicare Part D plan, Medicaid may take over as your primary drug payer once you are enrolled. This can lower your copays on medications, but it can also mean a different formulary (list of covered drugs). Your Medicaid office will explain how your drug coverage works once you are approved.
State-by-state differences you need to know
Medicaid rules are not federal — each state sets its own income limits, asset limits, covered services, and process process. A person who qualifies for Medicaid in one state might not may have access to in another. Some states have expanded Medicaid to cover more people; others have not. Some states cover dental and vision; others do not. These differences matter.
Before you explore, find your state's Medicaid website and read the current income and asset limits. Call your state Medicaid office with questions about your specific situation. Do not assume that because you heard something about Medicaid in another state, it applies to you. Your state's rules are the only ones that matter for your case.
Frequently Asked Questions
Will having Medicaid affect my Medicare benefits?
No. Your Medicare coverage stays the same. Medicaid straightforward helps pay the costs that Medicare does not cover. You keep your Medicare card and your doctors do not change.
What if my income goes above the Medicaid limit?
You will lose Medicaid coverage. Most states give you a grace period of one or two months before they terminate you, so report income changes right away. If your income drops again, you can reapply.
Can I have Medicaid in one state and Medicare in another?
Medicare is federal, so you have it everywhere. Medicaid is state-based. If you move, you must explore for Medicaid in your new state. Coverage does not transfer between states.
Do I have to be retired to may have access to for Medicaid with Medicare?
No. You must meet the income and asset limits, but there is no age or work requirement. Anyone on Medicare whose income is low enough can pursue Medicaid.
What if I am denied Medicaid?
You have the right to appeal. Your state Medicaid office will tell you why you were denied and how to request a hearing. You can bring documents, witnesses, or a representative to the hearing to argue your case.