Whether you need Medicare Part B depends on your income and which state you live in

If you have Medicaid, you may still need to enroll in Medicare Part B — or you may not. The answer depends on whether you may have access to for both programs at the same time, which happens when your income and assets fall below the limits for each program in your state. When you have both, you are called a dual-may be able to access beneficiary, and the two programs work together to cover your medical costs.

The key question is whether you are required to pay the Part B premium. If your income is low enough that Medicaid covers your Part B premium for you, enrollment makes sense because it expands what gets paid. If your income is too high for Medicaid to help with the premium, you may decide the cost is not worth it — though there are trade-offs to understand before you skip it.

Key Takeaways

  • If you may have access to for both Medicare and Medicaid at the same time, Medicaid will usually pay your Medicare Part B premium for you, making enrollment free.
  • Some people with Medicaid income limits do not may have access to for Medicare at all because they are not yet 65 or do not have enough work history, so Part B is not an option.
  • If you delay enrolling in Part B when you are supposed to, you may face a permanent penalty on your premium even after you do enroll.
  • Medicaid covers some costs that Medicare Part B does not, so having both programs protects you more than having Medicaid alone.
  • Your state's Medicaid rules determine whether you can stay on Medicaid if you turn down Part B, and the rules vary widely.

When Medicaid pays your Part B premium for you

If your income is low enough to may have access to for both Medicare and Medicaid, your state's Medicaid program will usually pay your Medicare Part B premium automatically. This is called Medicaid buy-in or Medicaid as secondary payer. When Medicaid covers the premium, there is no cost to you to enroll in Part B.

Your state Medicaid office handles this. Once you are found to be may be able to access for both programs, they send the premium payment to Medicare on your behalf each month. You do not have to do anything except stay enrolled in Medicaid and report changes in your income or household size.

This arrangement is almost always the better choice, because Part B covers doctor visits, outpatient care, and medical equipment that Medicaid alone may not cover fully. Having both programs means more of your medical bills get paid.

When you may have access to for Medicare but Medicaid will not pay the premium

Some people may have access to for Medicare but their income is too high to may have access to for Medicaid in their state. In this situation, you have to decide whether to pay the Part B premium yourself. The standard premium in 2024 varies based on your income, but you can contact Medicare at 1-800-MEDICARE to learn what you would pay.

If you turn down Part B at this point, you will not face a penalty as long as you enroll later when your circumstances change — for example, if your income drops and you become Medicaid-may be able to access. However, you should enroll as soon as you become may be able to access for Medicaid, because waiting can trigger a penalty.

Some people in this situation choose to stay uninsured for Part B services and rely on Medicaid alone. This is a real choice, but it means you will pay out of pocket for doctor visits and tests that Part B would have covered. Talk to your state Medicaid office about what your coverage would look like without Part B before you decide.

The penalty for not enrolling when you should have

If you are supposed to enroll in Part B — because you are 65 or older and have enough work history — and you do not, Medicare charges a late enrollment penalty. This penalty is a percentage added to your Part B premium for as long as you have Medicare, and it does not go away.

The penalty is 10 percent of the standard premium for each full year you were may be able to access but did not enroll. If you were supposed to enroll at 65 and you wait until 67, you owe two years of penalty — roughly 20 percent extra on your premium forever.

However, if you have Medicaid when you turn 65, you usually do not face this penalty even if you delay enrolling in Part B, because Medicaid is considered a reason to delay. Once your Medicaid coverage ends or your income rises above the Medicaid limit, you have a window to enroll in Part B without penalty. Your state Medicaid office or Social Security can tell you whether you are protected from the penalty in your situation.

What Medicaid covers that Part B does not

Medicaid and Medicare Part B overlap in some areas but cover different things in others. Medicaid covers long-term care in a nursing home, personal care information at home, and dental care — services that Medicare Part B does not cover at all. Medicaid also covers prescription drugs through its own drug program, separate from Medicare's Part D.

If you have both programs, Medicaid acts as a safety net for costs that Part B does not pay. For example, if Part B covers 80 percent of a doctor visit, Medicaid may cover the remaining 20 percent. This is why having both programs is usually better than having Medicaid alone, even if you have to pay the Part B premium yourself.

The exact coverage varies by state, so ask your Medicaid caseworker what services are covered under your state's plan. Some states are more generous than others.

How to learn about you may have access to for both programs

Contact your state Medicaid office directly. You can find the phone number on your Medicaid card or by searching "[your state] Medicaid" online. Tell them you are turning 65 or that you have recently turned 65, and ask whether you may have access to for both Medicare and Medicaid.

If you already receive Social Security, Medicare will enroll you in Part A automatically when you turn 65. Part A covers hospital stays and is free. Part B is the optional program that covers doctor visits, and that is where the question of cost and coverage comes in.

Your state Medicaid office can tell you in one call whether you are may be able to access for Medicaid, whether they will pay your Part B premium, and what your coverage would look like. Write down the name of the person you speak with and the date, in case you need to follow up.

What happens if you move to a different state

Medicaid rules are different in every state, so if you move, your coverage may change. Some states have more generous income limits than others, and some states cover services that other states do not. When you move, contact your new state's Medicaid office within 30 days to report your address change.

Your new state will review your income and assets under their own rules. You may stay may be able to access for both programs, or you may lose Medicaid coverage. If you lose Medicaid, you will have to pay your Part B premium yourself. If you gain Medicaid coverage in the new state, they will start paying your Part B premium.

Do not assume your coverage stays the same. Call ahead before you move, or call within a week of arriving, so you know what to expect.

Frequently Asked Questions

Can I have Medicaid without Medicare Part B?

Yes, in most states. If you are under 65 or do not have enough work history to may have access to for Medicare, you can have Medicaid alone. If you are 65 or older and may have access to for Medicare but your income is too high for Medicaid to cover your Part B premium, you can stay on Medicaid without Part B — though you will pay more out of pocket for doctor visits.

Will I lose Medicaid if I enroll in Medicare Part B?

No. Enrolling in Part B does not affect your Medicaid status. In fact, when you enroll in Part B, Medicaid becomes your secondary payer and helps cover costs that Part B does not pay. You keep both programs.

What if I do not know whether I may have access to for Medicaid?

Call your state Medicaid office or visit their website. You can also call 211 (dial 2-1-1) and ask for a referral to your local Medicaid office. Have your Social Security number, birth date, and recent pay stubs or tax return ready. They can tell you in one call whether you may have access to.

Does my Part B premium change if Medicaid pays it?

No. The premium amount is the same whether you pay it yourself or Medicaid pays it for you. The only difference is who sends the money to Medicare. Medicaid handles the payment, and you do not see a bill.

What if my income goes up after I enroll in both programs?

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. At that point, you will have to pay your Part B premium yourself. Report any income changes to your Medicaid caseworker right away so you know when this will happen and can plan for the cost.