When You Have Medicaid, Do You Still Need Medicare?

The short answer: it depends on whether you are also may be able to access for Medicare

Having Medicaid does not automatically mean you do not need Medicare, and having Medicaid does not automatically mean you do need it. The two programs cover different things and work by different rules. Some people have both at the same time — they are called dual may be able to access. Others have only Medicaid. Whether you need Medicare depends on whether you meet Medicare's own rules, which are separate from Medicaid's.

Medicare is based on age (65 and older), disability, or end-stage renal disease. Medicaid is based on income and assets. You can be poor enough for Medicaid but not old or disabled enough for Medicare. You can also be old enough for Medicare but not poor enough for Medicaid. The two programs do not automatically talk to each other — you have to understand your own situation and sometimes take action yourself.

Key Takeaways

Medicare may be able to access is based on age 65 or older, disability, or end-stage renal disease; Medicaid may be able to access is based on income and assets — they are separate rules.
If you are 65 or older, you should sign up for Medicare Part A and Part B even if you have Medicaid, because Medicare becomes your primary payer and Medicaid fills gaps.
If you are under 65 and have Medicaid only because of disability or low income, you may not be may be able to access for Medicare unless you also have a disability that Medicare recognizes.
Missing the Medicare sign-up window when you turn 65 can cost you permanent penalties on your premiums, even if Medicaid covers you in the meantime.
Dual may be able to access people (with both programs) should understand which program pays first and what each covers, because the order matters for your out-of-pocket costs.

When you turn 65, you need Medicare even if you have Medicaid

At 65, you become may be able to access for Medicare based on age alone — your income does not matter. If you also have Medicaid, you now have both programs. This is not optional. Medicare becomes your primary payer, meaning it pays first. Medicaid becomes your secondary payer and covers some of what Medicare does not.

You must sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) during your Initial Enrollment Period, which runs three months before the month you turn 65, through three months after. If you miss this window, you pay a permanent penalty on your Part B premium for as long as you have Medicare — usually 10 percent more per year of delay. Medicaid covering you during those months does not erase the penalty. You cannot get it back.

The only exception is if you are still working and covered by your employer's health plan. In that case, you can delay Part B without penalty, but you must sign up for Part A at 65 (it has no penalty for delay, but it is still the right time to enroll).

If you are under 65 with Medicaid, you may not may have access to for Medicare

Medicaid covers people under 65 based on income, pregnancy, disability, or other state-specific rules. Medicare covers people under 65 only if they have a disability that Social Security recognizes, or end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or ALS (Lou Gehrig's disease). Having Medicaid does not make you may be able to access for Medicare.

If you are under 65 and on Medicaid for low income alone, you do not may have access to for Medicare. If you are under 65 and on Medicaid because of a disability, you may may have access to for Medicare only if that same disability qualifies under Social Security's rules — which are stricter than many states' Medicaid rules. You would need to have been receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for a certain period, or have been denied SSDI and appealed successfully.

If you are unsure whether your disability qualifies for Medicare, contact Social Security at 1-800-772-1213 or visit your local Social Security office. They can tell you whether you meet Medicare's disability standard.

How Medicare and Medicaid work together when you have both

When you have both programs, Medicare pays first for services it covers. Medicaid pays second for the same service, covering some or all of what Medicare did not pay. This includes Medicare premiums, deductibles, and copayments — Medicaid can cover these costs for you.

However, Medicaid covers only what Medicare covers. If Medicare does not cover a service, Medicaid will not cover it either just because you have Medicaid. For example, if Medicare does not cover dental work, Medicaid in your state might cover it separately — but that is a Medicaid benefit, not a result of having both programs.

Some states have programs specifically for people who are dual may be able to access. These programs may coordinate your care, limit which doctors you can see, or manage your prescriptions. Ask your Medicaid office whether your state has a dual may be able to access program and whether you are enrolled in it.

What happens to your Medicaid when you turn 65 and get Medicare

Turning 65 and becoming may be able to access for Medicare does not automatically end your Medicaid. In most states, you keep Medicaid as long as you still meet your state's income and asset limits. Your Medicaid coverage may change — some states move dual may be able to access people into special managed care plans — but you do not lose it.

However, some states have income limits for Medicaid that are very low. If your income rises above that limit (for example, because you start taking Social Security), you may lose Medicaid even though you have Medicare. Check with your state Medicaid office about your income limit and whether any changes in your situation would affect your coverage.

If you lose Medicaid, you will rely on Medicare alone. Make sure you understand what Medicare covers and what it does not, because you may have new out-of-pocket costs.

Special enrollment and coverage gaps if you switch between programs

If you have Medicaid and then become may be able to access for Medicare (for example, at 65 or after a disability approval), there may be a gap between when one program ends and the other begins. This is rare but can happen if paperwork is delayed.

If you are turning 65, sign up for Medicare at least one month before your 65th birthday to avoid any gap. If you are approved for Medicare disability, ask Social Security when your Medicare coverage starts — it usually begins the month you are approved, but there can be delays.

If you have a gap in coverage, you may be able to get retroactive coverage from either program. Contact your state Medicaid office and Medicare (1-800-MEDICARE) to report the gap and ask whether they can backdate your coverage.

Questions to ask your doctor and your benefits office

Before your 65th birthday or if you are unsure about your Medicare status, ask your doctor's office which insurance they bill first. Ask whether they accept both Medicare and Medicaid, or only one. Some providers do not accept Medicaid, and you need to know this before you rely on it.

Contact your state Medicaid office and ask: (1) Do I still may have access to for Medicaid if my income changes? (2) Will I be moved to a different Medicaid plan when I turn 65? (3) Does my state have a dual may be able to access program, and am I in it? (4) What is my income limit, and what counts toward it?

Contact Medicare at 1-800-MEDICARE and ask: (1) Am I may be able to access for Medicare? (2) When should I sign up? (3) What is my Initial Enrollment Period? (4) If I miss it, what penalties will I owe?

Frequently Asked Questions

Can I delay signing up for Medicare if Medicaid is covering me?

No. Medicaid covering you does not extend your Medicare enrollment window. If you miss your Initial Enrollment Period at 65, you will owe a permanent penalty on your Part B premium, even though Medicaid paid your bills in the meantime. The only exception is if you are still working and covered by an employer plan.

If I have Medicaid, do I have to pay Medicare premiums?

You still owe the premiums, but Medicaid may pay them for you. In most states, Medicaid covers the Part B premium and sometimes the Part D (prescription drug) premium for dual may be able to access people. Ask your Medicaid office whether they pay your Medicare premiums.

What if my state Medicaid office says I do not may have access to for Medicare?

Medicaid offices do not decide Medicare may be able to access — only Social Security and Medicare do. If you believe you may have access to for Medicare (because you are 65, disabled, or have end-stage renal disease), contact Social Security or Medicare directly. Do not rely on what a Medicaid worker tells you about Medicare rules.

Will I lose my Medicaid if my income goes up after I turn 65?

It depends on your state's income limit. Some states have very low limits, and a small increase in income (from Social Security, a pension, or other sources) can disqualify you. Contact your state Medicaid office and ask what your income limit is and whether any changes in your situation would affect your coverage.

What should I do right now if I am turning 65 soon?

Contact Medicare at 1-800-MEDICARE at least one month before your 65th birthday and ask about signing up for Part A and Part B. Have your Social Security number ready. If you have Medicaid, tell Medicare that too — they may be able to coordinate your enrollment. Do not wait until after your birthday.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.