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

If you are 65 or older, blind, or disabled, you may be covered by both programs at once. Medicare is federal health insurance run by the Centers for Medicare & Medicaid Services. Medicaid is a joint federal and state program that covers low-income people. The two programs work together — Medicare pays first for services it covers, and Medicaid can cover costs Medicare does not, like copayments, coinsurance, and some services Medicare leaves out entirely.

People with both programs are called dual may be able to access or dually may be able to access. You do not have to choose one or the other. In fact, if you meet the income and asset limits for Medicaid in your state, you may be automatically enrolled in both once you turn 65 and become may be able to access for Medicare.

The rules for having both vary by state, because each state sets its own Medicaid income and asset limits. Some states are more generous than others. Your state Medicaid office is the place to find out whether you may have access to in your specific situation.

Key Takeaways

  • You can hold both Medicare and Medicaid at the same time if you meet your state's income and asset limits for Medicaid.
  • Medicare pays first for covered services, and Medicaid can pay for copayments, coinsurance, and services Medicare does not cover.
  • Income and asset limits for dual coverage vary by state, so you must contact your state Medicaid office to learn what applies where you live.
  • If you are 65 or older and have low income, your state may automatically enroll you in both programs without you having to take any action.
  • Some states offer special Medicaid programs designed specifically for people who are already on Medicare.

How Medicare and Medicaid work together when you have both

When you have both programs, the order in which they pay matters. Medicare is always the primary payer, meaning it pays its share of the bill first. Medicaid is the secondary payer and covers what Medicare does not — but only up to what Medicaid itself would have paid for that service.

For example, suppose you see a doctor and the bill is $100. Medicare covers 80 percent of the approved amount, leaving you with a $20 copayment. If you have Medicaid, Medicaid can pay that $20 copayment for you. For services Medicare does not cover at all — like dental work, vision care, or hearing aids — Medicaid may cover them if your state's Medicaid program includes them.

This coordination means you typically pay less out of pocket than you would with Medicare alone. However, what Medicaid covers beyond Medicare varies widely by state. Some states cover dental and vision; others do not. Your state Medicaid office can tell you exactly what is covered in your state.

Income and asset limits vary by state

To have both Medicare and Medicaid, you must meet your state's Medicaid income and asset limits. These limits are different in every state and change from year to year. Some states use the federal poverty level as a benchmark; others set their own thresholds.

Income limits typically range from about 74 percent to 100 percent of the federal poverty level, though some states go higher. Asset limits — the total value of money, property, and possessions you can own — also vary. In some states the limit is $2,000 for an individual; in others it is higher. Your home and one car are usually not counted toward the asset limit.

Because these numbers change and differ by state, the only way to know whether you may have access to is to contact your state Medicaid office directly or use your state's online screening tool. The Medicaid.gov website has a link to your state's program, or you can call 1-800-MEDICARE to be referred to your state office.

Automatic enrollment when you turn 65

If you are already receiving Supplemental Security Income (SSI) or Aid to Families with Dependent Children (AFDC), your state may automatically enroll you in both Medicare and Medicaid when you turn 65. You do not have to do anything — the enrollment happens on its own.

However, automatic enrollment does not happen in every state, and not everyone who qualifies receives it. If you turn 65 and do not hear from your state Medicaid office, contact them yourself. Waiting to enroll can mean losing coverage for months.

If you are not automatically enrolled but believe you meet the income and asset limits, you can contact your state Medicaid office to request enrollment. The process and timeline vary by state, but most states process requests within 30 to 45 days.

Special Medicaid programs for people on Medicare

Many states offer Medicaid programs designed specifically for people who are already on Medicare. These programs have different names in different states — some call them "Medicare Savings Programs," others use different titles — but they all serve the same purpose: to help pay Medicare premiums, copayments, and coinsurance for people with low income.

The may have access to Medicare Beneficiary (QMB) program is one example. It pays your Medicare Part B premium, copayments, and coinsurance if your income is below a certain level. The Specified Low-Income Medicare Beneficiary (SLMB) program pays only your Part B premium. Other states have programs that cover Part D prescription drug copayments or help with Part A premiums.

These programs are separate from full Medicaid but work the same way — they coordinate with Medicare to cover costs Medicare does not. Your state Medicaid office can tell you which programs exist in your state and whether you meet the income limits for each one.

What happens to your coverage if your income or assets change

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage but keep Medicare. If your income drops back below the limit, you can reapply for Medicaid. The timing of when coverage ends and begins depends on your state's rules and when you report the change.

Some states have a process called "spend-down," which allows you to become Medicaid-may be able to access by spending down your assets to the state limit. For example, if your assets are $500 over the limit, you might be able to spend that $500 on medical care and then may have access to for Medicaid. Not all states offer this option, and the rules are complex, so ask your state Medicaid office whether it applies to you.

If your circumstances change — you get a job, receive an inheritance, or your expenses drop — report it to your state Medicaid office. Continuing to receive Medicaid when you no longer may have access to can result in being asked to repay benefits, so it is important to stay current with your state.

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 and website through Medicaid.gov, or call 1-800-MEDICARE and ask for your state's Medicaid number. Have your Social Security number, birth date, and current income information ready.

Many states also have online screening tools that give you a quick answer about whether you might may have access to. These tools ask basic questions about your age, income, and assets and tell you whether to explore. An online screening is not a final decision, but it can save you time if you clearly do not may have access to.

If you are 65 or older and have low income, also ask your state Medicaid office about Medicare Savings Programs. You may may have access to for one of these programs even if you do not may have access to for full Medicaid, and they can significantly reduce your out-of-pocket costs.

Frequently Asked Questions

If I have both Medicare and Medicaid, do I have to use both insurance cards?

Yes. When you see a doctor or go to the hospital, give both your Medicare card and your Medicaid card. The provider will bill Medicare first, then send the remaining bill to Medicaid. If you only give one card, the provider may not bill Medicaid for what Medicare does not cover, and you could end up paying more than you should.

Can I lose Medicare if I lose Medicaid?

No. Medicare and Medicaid are separate programs. If your income rises and you lose Medicaid, you keep Medicare. You will straightforward have to pay more out of pocket for copayments and coinsurance that Medicaid was covering. If you are concerned about affording Medicare costs, ask about Medicare Savings Programs in your state.

What if my state does not cover something Medicaid covers in another state?

Medicaid benefits vary by state, and there is no way to transfer coverage across state lines. If you move to a different state, you must reapply for Medicaid in your new state. Your new state may cover different services. Contact your new state's Medicaid office as soon as you move to understand what is covered.

Do I have to be 65 to have both Medicare and Medicaid?

No. You can be younger than 65 and have both if you are blind or disabled and meet your state's Medicaid income and asset limits. You must be on Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) to may have access to. Contact your state Medicaid office to learn the specific rules for people under 65 in your state.

If I am on Medicare Advantage, can I also have Medicaid?

Yes. You can be enrolled in a Medicare Advantage plan and also have Medicaid. Medicaid will coordinate with your Advantage plan the same way it coordinates with Original Medicare — it pays copayments, coinsurance, and services your plan does not cover. Make sure your Advantage plan knows you have Medicaid so it can coordinate benefits correctly.