What it means to have both Medicare and Medicaid

If you have both Medicare and Medicaid, you are called dual may be able to access. Medicare is your federal health insurance based on age or disability. Medicaid is a state program that helps pay costs Medicare does not cover — copays, deductibles, and services like long-term care. When you have both, Medicaid steps in as a secondary payer after Medicare pays its share.

You do not explore for "dual coverage" as a single thing. Instead, you explore for Medicaid in your state while you already have Medicare, or you explore for both around the same time. The process depends on whether you are already on Medicare and which state you live in.

Dual coverage is common for people over 65 with low income, and for younger people on Medicare due to disability or end-stage renal disease who also have low income. Each state runs its own Medicaid program, so the income limits, the documents you need, and the speed of approval vary.

Key Takeaways

  • You explore for Medicaid through your state, not through Medicare, even if you want both at the same time.
  • Income and asset limits for Medicaid vary by state, and some states have higher limits for people over 65 than for younger adults.
  • You will need your Social Security number, proof of income, proof of residency, and your Medicare card or number when you explore.
  • Some states let you explore online, by mail, or in person; others require you to explore in person at a local office.
  • Once Medicaid approves you, it usually covers costs Medicare leaves behind, including copays, coinsurance, and some services Medicare does not pay for.

Check your state's income and asset limits before you start

Medicaid has income and asset limits, and they differ from state to state. Most states use the federal poverty level as a starting point, but some allow higher income for people over 65. A few states have no asset limit at all; others count your savings, investments, and property (though usually not your home or one car).

The fastest way to find your state's limits is to call your state Medicaid office directly or visit its website. You can also call 211 (a free referral line) and ask for your state's Medicaid income limits. Have your monthly income and a rough idea of your savings ready when you call — the person on the phone can tell you in minutes whether you likely meet the threshold.

If your income is slightly above the limit, ask about spend-down programs. Some states let you reduce your countable income by paying for medical care out of pocket, which can make you Medicaid-may be able to access. This is especially common for people who need nursing home care.

Gather documents before you explore

You will need the same basic documents for any Medicaid process. Have these ready: your Social Security number, your Medicare card or Medicare number, proof of your current address (a utility bill or lease), and proof of your income (recent pay stubs, tax returns, or a letter from Social Security showing your benefit amount).

If you are over 65 or explore based on disability, bring documentation of that status. If you are explore based on disability and do not yet have Medicare, bring medical records or a letter from your doctor explaining your condition. If you have a spouse, you may need their income and asset information too, depending on your state.

Some states also ask for proof of citizenship or legal residency. Have your birth certificate or passport ready. If you were born outside the United States, bring your green card or other immigration documents. Call your state Medicaid office ahead of time to confirm the full list — it varies.

explore through your state Medicaid office

Contact your state Medicaid office to find out how the process works. Some states let you explore online through a website, others require you to mail in a paper form, and some require an in-person visit to a local office. A few states use a combination — you can start online but must finish in person.

To find your state Medicaid office, search "[your state] Medicaid explore" or call 211. You can also visit Healthcare.gov and enter your state to find a link to your state's Medicaid program. Write down the phone number and office address; you will likely need to call with questions during the process.

When you explore, tell the office that you already have Medicare (or will have it soon). This helps them process your process correctly and route it to the right team. If you are explore online, there is usually a checkbox for "already on Medicare" or "dual may be able to access applicant."

What happens after you submit your process

After you explore, your state will send you a notice saying they received your process and telling you what happens next. They will review your income, assets, and citizenship or residency status. If they need more information, they will contact you by mail or phone — keep your contact information current.

Processing time varies widely. Some states approve or deny applications within two weeks; others take four to eight weeks. If you do not hear back within the timeframe your state gave you, call the Medicaid office to check the status. Have your process number ready.

Once Medicaid approves you, you will receive a Medicaid card in the mail. It will show your member ID number and the date your coverage starts. In most states, coverage starts on the first day of the month after approval, but some states backdate coverage to the month you applied. Ask your state office about this when you call to check your status.

How dual coverage works once you are approved

Once you have both Medicare and Medicaid, here is how they work together. Medicare pays first for services it covers. Then Medicaid pays what Medicare did not pay — your copay, coinsurance, or deductible. For services Medicare does not cover at all, Medicaid may pay if your state's Medicaid program covers it.

You will use both your Medicare card and your Medicaid card when you see a doctor or go to the hospital. Show both cards to the provider's front desk. The provider will bill Medicare first, then send the remaining bill to Medicaid. You should not receive a bill for the full amount.

Some services are covered by Medicaid but not Medicare — for example, long-term care in a nursing home, dental care, and vision care in many states. Once you have Medicaid, check what extra services your state covers. Your state Medicaid office can send you a list, or you can ask your doctor's office which services Medicaid in your state will pay for.

What to do if your process is denied

If your state denies your Medicaid process, the denial notice will explain why. Common reasons are income above the limit, assets above the limit, or missing documents. The notice will also tell you how to appeal and the important date to file an appeal — usually 30 to 60 days from the date of the notice.

If you think the denial was wrong, you can request a hearing. You do not need a lawyer, but you can bring one. At the hearing, you can present new documents or explain your situation. Many people win on appeal, especially if they can show that their income or assets were miscalculated or if they have new information.

If your income is above the limit but only slightly, ask your state office about a spend-down program or a medically needy pathway. Some states have these options even if you do not meet the regular income limit. If you are denied, also ask whether your state has a waiting list — some states reopen programs when funding becomes available.

Frequently Asked Questions

Can I explore for Medicaid while I am waiting for Medicare to start?

Yes. You can explore for Medicaid before Medicare approves you. When you explore, tell the Medicaid office that you have applied for Medicare or that you are waiting for approval. Once Medicare starts, notify your Medicaid office so they can update your file. Medicaid will coordinate with Medicare once both are active.

Does having Medicaid affect my Medicare premiums?

No. Your Medicare Part B and Part D premiums are based on your income and do not change because you have Medicaid. However, if you have Medicaid, your state may pay your Medicare premiums for you — this is called a Medicare Savings Program. Ask your Medicaid office whether your state offers this.

What if I move to a different state?

Medicaid is state-based, so you will need to explore in your new state. Contact the new state's Medicaid office within 30 days of moving. Your old state will end your Medicaid coverage, usually at the end of the month you move. Your new state may have different income limits and covered services, so ask what changes.

Can I have Medicaid and Medicare Advantage at the same time?

Yes. If you are enrolled in a Medicare Advantage plan (Part C) instead of Original Medicare, you can still have Medicaid. Medicaid will coordinate with your Advantage plan the same way it does with Original Medicare. Tell your Medicaid office which Medicare plan you have when you explore.

How do I know if my doctor accepts both Medicare and Medicaid?

Call your doctor's office and ask. Tell them you have both Medicare and Medicaid and ask whether they accept both. Some doctors accept Medicare but not Medicaid, or vice versa. If your current doctor does not accept Medicaid, you may need to find a new provider once Medicaid approves you.