You can have both Medicare and Medicaid — and many seniors do

If you may have access to for both programs, you can be enrolled in each at the same time. Medicare is federal health insurance based on age or disability. Medicaid is a state program based on income and assets. They work together: Medicare pays first for covered services, and Medicaid can cover what Medicare does not pay, including copays, coinsurance, and some services Medicare does not cover at all. People with both are called dual may be able to access or dually may be able to access.

Having both programs means lower out-of-pocket costs than Medicare alone, but it also means navigating two separate systems. You will deal with two different sets of rules, two different customer service lines, and two different renewal dates. Understanding how they coordinate is the key to using both programs well.

Key Takeaways

  • You can hold both Medicare and Medicaid at the same time if you meet the income and asset limits set by your state for Medicaid.
  • Medicare pays first for services both programs cover, and Medicaid covers the amounts Medicare does not pay, such as copays and deductibles.
  • Medicaid also covers services Medicare does not, including long-term care, dental, and vision in most states.
  • Each program has its own enrollment period, renewal date, and rules, so you must track both separately.
  • Your state Medicaid office determines your Medicaid coverage, while Medicare is the same nationwide.

How Medicare and Medicaid work together

When you have both programs, the order of payment is fixed: Medicare always pays first for any service both programs cover. This is called the coordination of benefits. Medicare pays its share based on what it covers and what you owe. Then Medicaid steps in and pays what Medicare did not cover — your copay, coinsurance, or deductible.

For example, if you see your primary care doctor and Medicare covers the visit but charges you a $15 copay, Medicaid will pay that $15. If you have an X-ray that costs $200, Medicare might pay $160, leaving you $40 out of pocket. Medicaid then pays your $40 share. This is why dual may be able to access people often have very low out-of-pocket costs.

Medicaid also covers services Medicare does not cover at all. In most states, this includes dental work, vision care, hearing aids, and long-term care (nursing home or home care). The exact services vary by state, so what Medicaid covers where you live may differ from what it covers in another state.

Income and asset limits for Medicaid while on Medicare

To have Medicaid while you are on Medicare, your income and assets must fall below your state's limits. Income limits vary widely — some states allow monthly income up to $1,000 or $1,100, while others allow more. Asset limits also differ: some states set the limit at $2,000, others at $4,000 or higher. A few states have no asset limit at all for seniors on Medicare.

Your state Medicaid office is the only source that can tell you the exact limits where you live. You can find your state office through the Medicaid website or by calling 1-800-MEDICARE and asking for your state Medicaid number. When you call, have your Social Security number, current income, and a list of your assets (savings, property, vehicles) ready.

If your income or assets are slightly over the limit, you may still be able to use a spend-down — a process where you use money on medical or long-term care costs to bring your countable assets below the limit. Spend-downs are complex and state-specific, so ask your state Medicaid office whether this option exists where you live.

Types of dual may be able to access plans and programs

If you are dual may be able to access, you have choices about how to receive your Medicare and Medicaid benefits. You can stay in Original Medicare (the federal program) and your state Medicaid program separately, managing two cards and two sets of rules. Or you can join a Medicare-Medicaid Plan, also called a D-SNP (Dual may be able to access Special Needs Plan), which combines both benefits into one plan.

A D-SNP is a Medicare Advantage plan that also includes your Medicaid benefits. You get one insurance card, one customer service number, and coordinated care. Not all areas have D-SNPs, and not all D-SNPs accept everyone — some have waiting lists or specific enrollment windows. Your state Medicaid office or 1-800-MEDICARE can tell you which D-SNPs are available in your area.

Some states also run Programs of All-Inclusive Care for the Elderly (PACE), which serve dual may be able to access seniors who need long-term care. PACE provides medical care, social services, and long-term care through one organization. PACE is not available everywhere, and enrollment is limited, but it can be a good option if you may have access to and it operates near you.

How to learn about you may have access to for Medicaid

Start by contacting your state Medicaid office. You can find the phone number through the Medicaid website or by calling 1-800-MEDICARE. Have your Social Security number, birth date, current monthly income (from Social Security, pensions, or work), and a list of your assets ready when you call.

The Medicaid office will ask about your income and assets and tell you whether you meet your state's limits. If you do, they will send you a form to complete. If you do not meet the limits now, ask whether your state has a spend-down option or whether you might may have access to in the future if your income or assets change.

You can also visit your state Medicaid office in person if you prefer to explore face-to-face. Many offices have walk-in hours, though some require an appointment. Bring documents that show your income (recent pay stubs, Social Security statement, pension letter) and your assets (bank statements, property deed, vehicle registration).

Renewal and changes you must report

Medicare and Medicaid have separate renewal dates. Medicare renews on your birthday each year. Medicaid renews on a date your state sets — often once a year, though some states renew more frequently. You will receive renewal notices from each program separately, usually 30 to 60 days before the renewal date.

You must report certain changes to both programs. If your income increases or decreases, if you move, if your address changes, or if your household size changes, tell both Medicare and Medicaid. Some changes must be reported within 30 days. Failing to report can result in overpayment, which you may have to repay, or loss of coverage.

Keep your Medicare and Medicaid renewal notices and any letters you receive. Mark the renewal dates on your calendar. If you miss a renewal important date, you may lose coverage. If this happens, contact your state Medicaid office and Medicare when ready — some situations allow for a grace period or late enrollment.

What to ask your doctor and what to watch for

When you see a doctor or go to the hospital, tell them you have both Medicare and Medicaid. Give them both insurance cards. Some providers are not familiar with how dual coverage works, so it helps to explain: Medicare pays first, then Medicaid pays what Medicare does not cover.

Watch for bills that do not make sense. If you receive a bill after a visit or hospital stay, check it against your Medicare Summary Notice (which Medicare sends quarterly) and your Medicaid Explanation of Benefits (which your state sends). If a provider bills you for something Medicare or Medicaid should have paid, contact the provider's billing department and ask them to resubmit the claim.

If a provider refuses to accept Medicaid, report it to your state Medicaid office. Providers who accept Medicare must also accept Medicaid for the same services. If you are denied care because of Medicaid, that is a violation you can report.

When to contact Medicare, Medicaid, or both

Call 1-800-MEDICARE (1-800-633-4227) if you have questions about Medicare coverage, your Medicare bill, or whether you are may be able to access for Medicare. This line is open 24 hours a day, seven days a week. They can also connect you to your state Medicaid office.

Call your state Medicaid office if you have questions about Medicaid coverage, your Medicaid renewal, or whether you meet income and asset limits. The phone number is on your Medicaid card or on your state's Medicaid website. Hours vary by state, but most are open weekdays during business hours.

If you are unsure which program should pay for something, call both. It is better to ask twice than to end up with an unexpected bill. Keep notes of who you spoke with, the date, and what they told you — this helps if there is a dispute later.

Frequently Asked Questions

Can I have Medicaid if I am already on Medicare?

Yes, if your income and assets are below your state's limits. Medicaid is based on financial need, not age. Many people over 65 on Medicare also have Medicaid because their income is low enough to meet the state's rules.

Does Medicaid pay for things Medicare does not cover?

Yes. Medicaid covers many services Medicare does not, including long-term care, dental, vision, and hearing aids in most states. Medicaid also covers your Medicare copays and deductibles. The exact services vary by state.

What happens if my income goes up after I am approved for Medicaid?

You must report the income increase to your state Medicaid office. If your new income exceeds the state limit, you may lose Medicaid coverage. Some states allow a grace period before coverage ends, so report the change right away and ask what happens next.

Do I have to join a D-SNP plan, or can I stay in Original Medicare?

You can choose. You can keep Original Medicare and your state Medicaid program separate, or you can join a D-SNP if one is available in your area. D-SNPs are optional. If you stay in Original Medicare, you keep more freedom to see any doctor who accepts Medicare.

What if I disagree with a decision Medicare or Medicaid made about my coverage?

You have the right to appeal. Medicare appeals go through a formal process that starts with your Medicare Summary Notice. Medicaid appeals go through your state office. Both programs must give you a chance to explain why you think the decision is wrong. Ask for the appeal process when you receive the decision you disagree with.