You need to meet income and asset limits set by your state, and you must be enrolled in Medicare Part A or B already

Dual enrollment — holding both Medicare and Medicaid at the same time — is not automatic. You must meet your state's income threshold (usually 75% to 100% of the federal poverty level, depending on your state and age) and have limited assets. You also cannot straightforward sign up for both; Medicaid looks at your Medicare enrollment status first, so you need to be on Medicare before Medicaid will consider you.

The process differs by state because each state runs its own Medicaid program within federal guidelines. Some states are more generous with income limits; others are stricter. Your state's Medicaid office is the only place that can tell you whether you meet the threshold in your location.

Dual coverage exists because Medicare alone does not cover long-term care, dental, vision, or hearing aids — gaps that Medicaid fills. People who may have access to for both typically pay lower out-of-pocket costs and have access to more services than Medicare-only enrollees.

Key Takeaways

  • You must already be enrolled in Medicare Part A or Part B before you can be considered for Medicaid.
  • Income limits vary by state but are generally between 75% and 100% of the federal poverty level, which is roughly $1,000 to $1,400 per month for a single person in 2024.
  • Asset limits also vary by state; most allow $2,000 to $8,000 in countable resources for a single person, though some states have higher thresholds.
  • You must contact your state Medicaid office directly to learn your state's specific limits and to begin the process.
  • Some people become dual-may be able to access automatically when they turn 65 and enroll in Medicare; others must request Medicaid separately.

Income and asset limits that determine dual may be able to access

Your state sets the income ceiling for Medicaid. Most states use one of three thresholds: 75% of the federal poverty level, 100% of the federal poverty level, or 120% of the federal poverty level. The federal poverty level changes each year. For 2024, 100% of the poverty level for a single person is approximately $1,140 per month; 75% is roughly $855 per month.

Your state also counts your assets — savings, investments, property you own (except your home and car). Most states allow between $2,000 and $8,000 in countable assets for a single person. Some states have higher limits for people over 75 or those in nursing facilities. Your home and one vehicle are usually not counted, but a second property or vehicle typically is.

Income includes Social Security, pensions, wages, and interest from savings. Some income is excluded: a small amount of unearned income (often $20 per month) and work income (often the first $65 per month plus half of the remainder). Your state's Medicaid office can tell you exactly what counts and what does not in your situation.

The difference between Medicaid categories for dual-may be able to access people

States use different names for dual-may be able to access programs, but the most common are may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and may have access to Individual (QI). Each covers different costs and has different income limits.

QMB is the most comprehensive. It pays your Medicare Part B premium, deductible, and coinsurance. Income limit is usually 100% of the federal poverty level. SLMB pays only your Part B premium and has a slightly higher income limit, usually 120% of poverty. QI also pays your Part B premium but has the highest income limit, usually 135% to 175% of poverty, and is often the easiest to get into.

Your state may also offer Medicaid Buy-In programs for working people with disabilities, or Medicare Savings Programs that cover premiums and cost-sharing. The program you end up in depends on your income, age, and your state's available programs. Your state Medicaid office will determine which one you fit into.

How to find your state Medicaid office and start the process

Contact your state Medicaid office directly — do not rely on a general Medicare line. You can find your state office through the Centers for Medicare & Medicaid Services (CMS) website at medicaid.gov, which has a state-by-state directory with phone numbers and websites. You can also call 211 (dial 2-1-1 from any phone) and ask for your state Medicaid office.

When you call, have your Social Security number, Medicare number, and recent pay stubs or benefit statements ready. Tell them you want to know if you meet the income and asset limits for dual coverage. Many states now let you start the process online through their Medicaid portal, but calling is often faster because staff can answer questions about your specific situation on the spot.

Some states automatically enroll you in a dual program when you turn 65 and sign up for Medicare if your income is low enough. Others require you to request it. Ask your state office whether you were automatically considered or whether you need to submit a separate request.

Documents and information you will need to provide

Medicaid will ask for proof of citizenship or immigration status, proof of income (recent pay stubs, Social Security award letter, pension statements), and proof of assets (bank statements, investment account statements). You will also need your Medicare card and your state ID or driver's license.

If you are explore for a spouse, you will need the same documents for both of you. If your income or assets have changed recently, bring documentation of that change — a termination letter from a job, a notice of benefit increase, or a bank statement showing a withdrawal or deposit.

Different states ask for different documents and accept different formats. When you call your state Medicaid office, ask exactly what they need and whether you can submit documents by mail, email, or in person. Some states process applications faster if you submit everything at once rather than sending documents in pieces.

Timeline and what happens after you submit your information

Most states have a legal important date of 30 to 45 days to make a decision on your Medicaid request, though some take longer if they need more information from you. During that time, your state will verify your income and assets with Social Security, the IRS, and banks if necessary.

If your state approves you, your Medicaid coverage usually starts on the first day of the month after approval, though some states backdate coverage to the month you applied. Your state will send you a Medicaid card and a notice explaining what services are covered and what your cost-sharing is (if any).

If your state denies you, they must send a written notice explaining why and telling you how to request a hearing to appeal the decision. You have a time limit to appeal — usually 60 to 90 days — so read the notice carefully and act quickly if you disagree.

What dual coverage pays for that Medicare alone does not

Medicare covers hospital stays, doctor visits, and some outpatient services, but it has gaps. Medicaid fills many of them: long-term care in a nursing home or assisted living facility, personal care services (help with bathing, dressing, toileting), dental care, vision care, hearing aids, and transportation to medical appointments.

Medicaid also typically covers prescription drugs through its own formulary, which may differ from Medicare's Part D formulary. If you are dual-may be able to access, you are usually enrolled in Medicaid's drug coverage instead of Part D, and your out-of-pocket costs are often lower.

The exact services covered depend on your state's Medicaid program. Some states are more generous than others. Your state Medicaid office or your Medicaid card documentation will list what is covered in your state.

Common reasons people are denied and how to respond

The most common reason for denial is income above your state's limit. If you are just slightly over, ask your state office whether any income is excluded or whether your state has a higher limit for people over 75 or in certain living situations. Some states also allow a small monthly income disregard that can push you under the limit.

Asset limits are the second common reason. If you are over the limit, ask whether your state allows a "spend-down" period — a time during which you can reduce your assets by paying medical bills or other allowed expenses and then reapply. Some states allow this; others do not.

A third reason is missing documentation. If your state denies you because they could not verify your information, ask what specific documents they need and submit them within the appeal window. Many denials based on missing paperwork are reversed once you provide what was requested.

Frequently Asked Questions

Do I have to be on Medicare Part A and Part B, or is Part A alone enough?

Part A alone is usually enough to may have access to for Medicaid, though some states require Part B enrollment as well. Call your state Medicaid office with your Medicare enrollment status and they will tell you whether you meet that requirement. If you have only Part A, ask whether enrolling in Part B would help you may have access to for dual coverage.

What happens to my dual coverage if my income goes up?

If your income rises above your state's limit, you will lose Medicaid coverage. Your state will send you a notice before this happens, usually giving you a month to report the change. You will keep Medicare, but you will lose Medicaid's additional coverage. If your income drops again later, you can reapply.

Can I have dual coverage in one state and then move to another?

No. Medicaid is state-based, so when you move, your old state's coverage ends and you must explore in your new state. Income and asset limits differ between states, so you may may have access to in one state but not another. Contact your new state's Medicaid office within 30 days of moving to start a new process.

If I am denied for dual coverage, can I still get help paying my Medicare costs?

Possibly. Some states have other programs for people with low income who do not meet dual-coverage limits. Ask your state Medicaid office about Medicare Savings Programs, charity care programs, or pharmaceutical information programs. 211 can also connect you to local resources that help with medical costs.

How often do I have to reapply for dual coverage?

Medicaid requires periodic recertification, usually once a year. Your state will send you a notice before your coverage expires, telling you what documents to submit to renew. If you do not respond by the important date, your coverage will end. Mark the renewal date on your calendar and submit your documents early to avoid a gap.