What It Means to Have Both Medicare and Medicaid

You can have both Medicare and Medicaid at the same time. When you do, you are called dual may be able to access. Medicare is your federal health insurance based on age or disability. Medicaid is your state's program for people with low income. Having both means Medicare is your primary insurance — it pays first — and Medicaid fills in gaps like copayments, deductibles, and services Medicare does not cover.

You do not choose to be dual may be able to access. You become dual may be able to access when you meet the rules for both programs at the same time. This happens most often for people over 65 with low income, or for younger people on Social Security Disability Insurance (SSDI) whose income stays below their state's Medicaid limit.

Being dual may be able to access is valuable because it reduces what you pay out of pocket. Medicaid can cover your Medicare premiums, your Part B deductible, and prescription drugs that Medicare does not. But the rules for having both are strict, and they differ by state.

Key Takeaways

  • You become dual may be able to access automatically when you meet income and resource limits for both Medicare and your state's Medicaid program — you do not have to request it.
  • Income limits for Medicaid vary by state and change each year, so you must check your state's current threshold rather than assuming you may have access to based on last year's rules.
  • If your income or resources rise above your state's Medicaid limit, you lose Medicaid coverage but keep Medicare, which means your out-of-pocket costs will jump.
  • Some states offer programs like may have access to Medicare Beneficiary (QMB) that help pay Medicare costs even if your income is slightly too high for full Medicaid.

Income and Resource Limits That Determine Dual may be able to access

To be dual may be able to access, your income must be low enough to meet your state's Medicaid threshold. For people 65 and older, most states set the limit at or near the federal poverty line, which changes each year. In 2024, the federal poverty line for a single person is around $1,500 per month, but your state may set its own limit higher or lower. Some states use 100 percent of the federal poverty line; others use 75 percent or 150 percent. You must check your specific state's current number.

Income includes Social Security, pensions, wages, and interest from savings. It does not include certain things like the first $20 of unearned income per month or the first $65 of earned income per month, depending on your state. Some states also exclude certain types of income entirely.

You also have a resource limit — a cap on how much money and property you can own. For most people on Medicaid, the resource limit is $2,000 for an individual or $3,000 for a couple, though some states set it higher. Resources include bank accounts, stocks, and property you own, but not your home or one car. If your resources exceed the limit, you lose Medicaid even if your income qualifies.

How You Become Dual may be able to access

You do not file a separate form to become dual may be able to access. When you turn 65 and enroll in Medicare, Social Security automatically checks whether you meet your state's Medicaid income and resource rules. If you do, your state's Medicaid program is notified, and Medicaid coverage begins. The same happens if you are already on Medicaid and turn 65 — Medicare enrollment triggers a Medicaid review.

If you are under 65 and on SSDI, you become may be able to access for Medicare automatically after 24 months of receiving SSDI payments. At that point, Social Security again checks your income and resources against Medicaid rules. If you may have access to, Medicaid coverage starts without you having to do anything.

However, if you are under 65 and not yet on SSDI, or if you have income or resources above your state's Medicaid limit, you will not be dual may be able to access. In those cases, you have only Medicare, and you must pay Medicare's full costs yourself.

What Medicaid Covers When You Are Dual may be able to access

When you have both programs, Medicaid covers the costs that Medicare does not. This includes your Medicare Part B premium (currently $164.90 per month for most people, though it can be higher if your income was above a certain level two years ago). Medicaid also pays your Part B deductible, which is $240 in 2024, and your copayments for doctor visits and hospital stays.

Medicaid also covers services Medicare does not, such as long-term care in a nursing home, personal care information, and dental care. The exact services vary by state. Some states cover vision and hearing aids; others do not. You should ask your state Medicaid office what services are available to you.

For prescription drugs, Medicaid can help when Medicare's coverage has a gap. Medicare Part D has a coverage gap called the "donut hole" where you pay more out of pocket. Medicaid can fill that gap, so your drug costs stay lower. Medicaid may also cover drugs that Medicare Part D does not.

When Your Income or Resources Change

If your income rises above your state's Medicaid limit, you lose Medicaid coverage when ready. This can happen if you receive a raise, start a new job, or receive a one-time payment like an inheritance or tax refund. When Medicaid ends, you keep Medicare, but you now pay the full cost of Medicare premiums, deductibles, and copayments. Your out-of-pocket costs can jump by hundreds of dollars per month.

You must report income changes to your state Medicaid office. The rules for when and how to report vary by state. Some states require you to report within 10 days; others give you a month. If you do not report and your income was actually too high, you may have to repay Medicaid for services it should not have covered.

If your income drops back below the limit, you can reapply for Medicaid. The process takes a few weeks. During the gap, you have only Medicare. Some people in this situation use a Marketplace plan to fill the gap, though that is usually more expensive than Medicaid.

Programs That Help If Your Income Is Slightly Too High

If your income is above your state's Medicaid limit but still very low, you may be able to get help through a may have access to Medicare Beneficiary (QMB) program. QMB pays your Medicare Part B premium, deductible, and copayments. The income limit for QMB is higher than the Medicaid limit — usually around 100 to 120 percent of the federal poverty line — so you may may have access to even if you do not may have access to for full Medicaid.

Other programs include Specified Low-Income Medicare Beneficiary (SLMB), which pays only your Part B premium, and may have access to Individual (QI), which also pays your Part B premium but has an even higher income limit. Each program has its own income threshold, and each state administers them differently. You can ask your state Medicaid office whether you may have access to for any of these programs.

These programs are not automatic. You must contact your state Medicaid office and ask about them. Some states make the process straightforward; others require more paperwork. If you are turned down for Medicaid, always ask whether you may have access to for QMB, SLMB, or QI before you assume you have no help available.

How to Find Out Your State's Rules

Because Medicaid rules vary by state, you must check your own state's current income and resource limits. The easiest way is to call your state Medicaid office directly. You can find the phone number by searching "[your state] Medicaid" online, or by calling 1-800-MEDICARE and asking for your state Medicaid office number.

When you call, have your Social Security number, income information, and a list of your resources ready. Ask specifically: What is the current income limit for a single person? What counts as income? What is the resource limit? What services does your state cover? How do I report a change in income?

You can also visit your state Medicaid website, though the information is sometimes hard to find. Look for a section called "may be able to access" or "Income Limits." If you cannot find it, call. It is worth the wait on hold to get the right answer for your state.

Frequently Asked Questions

If I am on Medicare and my income goes up, do I automatically lose Medicaid?

Not automatically, but you must report the income change to your state Medicaid office. Once they verify that your income is above the limit, Medicaid coverage ends. The timing depends on your state — some end coverage the month after they learn of the change; others give you a grace period. Always report changes right away so there is no confusion about what you owe.

Can I have Medicare and Medicaid in one state if I move to another state?

No. Medicaid is a state program, so when you move, you must explore for Medicaid in your new state. Your new state may have a different income limit, different services, and a different process process. explore as soon as you move so there is no gap in coverage. Medicare follows you automatically, but Medicaid does not.

What happens to my prescriptions if I lose Medicaid but keep Medicare?

You will be covered by Medicare Part D for prescription drugs, but your costs will be higher. You will pay a monthly premium for Part D, a deductible, copayments, and you will hit the coverage gap where you pay more. If you had Medicaid helping with these costs, losing Medicaid means you pay the full amount yourself. Talk to your doctor about lower-cost drugs before you lose Medicaid coverage.

Do I have to be 65 to be dual may be able to access?

No. You can be dual may be able to access at any age if you are on SSDI and your income and resources meet your state's Medicaid limits. You become may be able to access for Medicare after 24 months on SSDI, and at that point, if your income is low enough, you become dual may be able to access. Younger people with disabilities can have both programs just as older people can.

What should I ask my doctor about before I lose Medicaid?

Ask which of your current medications are covered by Medicare Part D and what your copayment will be. Ask whether there are lower-cost drugs that work just as well. Ask about any services you receive that Medicaid covers but Medicare does not — like physical therapy or mental health care — and whether you can continue them under Medicare. Plan ahead so you are not surprised by costs.