You can have both Medicare and Medicaid at the same time

If you have Medicare and a low income, you may be able to get Medicaid too. The two programs work together — Medicare is federal health insurance based on age or disability, while Medicaid is a joint federal-state program for people with limited income and assets. You do not have to choose one or the other. Many people over 65 or on disability hold both, and Medicaid often covers costs that Medicare does not, like long-term care, dental work, and vision care.

The path to getting Medicaid while on Medicare depends on your state, your age, and your income. Some states have made it easier by raising income limits; others have not. You will need to contact your state Medicaid office directly, because the rules and the process process differ significantly from state to state.

Key Takeaways

  • You can hold both Medicare and Medicaid at the same time, and Medicaid can pay for services Medicare does not cover, such as long-term care and dental work.
  • Your state Medicaid office determines whether you meet the income and asset limits, and these limits vary widely by state.
  • People over 65 with Medicare can often get Medicaid through their state's regular Medicaid program or through a special pathway called "Spend Down" if their income is slightly above the limit.
  • You must contact your state Medicaid office to find out the current income and asset limits and to begin the process.
  • The process usually requires proof of income, citizenship, residency, and Medicare enrollment, and processing takes two to four weeks in most states.

Income and asset limits for Medicare recipients

Medicaid has income and asset limits, but they vary by state and by age group. If you are over 65 and on Medicare, your state may use one of two different income limits: the "SSI limit" (based on Supplemental Security Income rules) or a higher "medically needy" limit. Some states allow you to "spend down" — meaning you can have income above the limit if you spend the excess on medical care, bringing your countable income below the threshold.

Asset limits also differ by state. Most states count cash, savings accounts, and investments, but not your home or one vehicle. The federal SSI asset limit is $2,000 for an individual and $3,000 for a couple, but your state may set a higher limit or use different rules for people over 65. You will need to contact your state Medicaid office to learn the exact limits that explore to you.

Some states have expanded Medicaid under the Affordable Care Act, which may make it easier for working-age adults to may have access to, but this does not directly affect Medicare recipients. What matters for you is whether your state has a Medicaid program for seniors and disabled people, and what the income and asset rules are in that program.

How to find your state Medicaid office

Your state Medicaid office is the only place that can tell you whether you meet the requirements and how to start the process. You can find it 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 1-800-MEDICARE and ask for your state Medicaid office contact information.

When you call or visit your state Medicaid office, have your Medicare card and Social Security number ready. Tell them you are on Medicare and want to know if you can get Medicaid. They will tell you the income and asset limits for your state, ask you basic questions about your situation, and either direct you to explore or tell you that you do not meet the requirements. Some states allow you to start the process over the phone; others require you to visit in person or submit a written form.

Documents you will need to gather

Most states ask for the same core documents when you explore for Medicaid. You will need proof of income (recent pay stubs, Social Security statements, or pension letters), proof of citizenship (birth certificate, passport, or naturalization papers), and proof of residency (utility bill or lease). You will also need to show your Medicare card and provide your Social Security number.

If you have assets — savings accounts, investments, or property — you may need to provide bank statements or property records. Some states ask for medical bills or prescriptions to show that you have ongoing health care costs. If you are explore through the "spend down" route, you will need documentation of medical expenses you have paid. Keep copies of everything you submit, and ask the Medicaid office which documents are required before you gather them all.

The process process and timeline

The process itself is usually a single form, though some states have separate forms for different types of Medicaid (for example, one for seniors and one for disabled people). You can often submit it by mail, in person, or online through your state's Medicaid portal. A few states allow phone applications. After you submit, the office will send you a notice telling you whether you have been approved, denied, or asked to provide more information.

Processing typically takes two to four weeks, though some states take longer if they need to verify information with Social Security or Medicare. If the office asks for more documents, respond as quickly as you can — delays in sending documents can extend the timeline. Once you are approved, Medicaid coverage usually starts on the first day of the month in which you applied or the month after, depending on your state's rules.

What Medicaid covers that Medicare does not

If you have both programs, Medicaid fills gaps in Medicare coverage. Medicare does not cover long-term care in a nursing home or assisted living facility, but Medicaid does — this is one of the biggest reasons people on Medicare seek Medicaid. Medicaid also covers dental care, vision care (including glasses), and hearing aids, which Medicare covers only in limited situations. Medicaid may also cover transportation to medical appointments and some prescription drugs that Medicare does not.

When you have both, Medicare is your primary insurance and pays first. Medicaid then pays some or all of the costs that Medicare does not cover, including copayments and deductibles. This is called "dual coverage" or being "dual may be able to access." The exact coverage depends on your state's Medicaid program, so ask your state office what services are covered under your state's plan.

Special situations: Spend Down and other pathways

If your income is slightly above your state's Medicaid limit, you may be able to use a "spend down" to become may be able to access. This means you can deduct medical expenses from your income to bring your countable income below the limit. For example, if the limit is $1,500 per month and you earn $1,700, you might be able to count $200 in medical bills (prescriptions, doctor visits, medical equipment) against your income, making you may be able to access.

Some states also have special Medicaid programs for people on Medicare, such as "Medicaid for the Aged, Blind, and Disabled" or programs that cover only specific services like nursing home care. Your state Medicaid office can tell you which programs you might be able to use. If you are denied regular Medicaid, ask whether you may have access to for any of these alternatives.

Common mistakes to avoid

One common mistake is not reporting all your income or assets accurately. Medicaid offices verify information with Social Security, the IRS, and banks, so underreporting will likely be caught and can result in denial or overpayment recovery. Another mistake is waiting too long to explore. If you think you might be may be able to access, contact your state office now — there is no penalty for asking, and coverage can start retroactively in some cases.

Do not assume that because you were denied Medicaid in the past, you are ineligible now. Income and asset limits change, and your situation may have changed. If you were denied, ask why, and contact your state office again if your circumstances have shifted. Finally, do not confuse Medicaid with Medicare Savings Programs (which help pay Medicare premiums and cost-sharing). These are different programs, and you may be able to get both.

Frequently Asked Questions

Will getting Medicaid affect my Medicare benefits?

No. Medicare and Medicaid are separate programs, and having Medicaid does not change your Medicare coverage or benefits. Medicaid straightforward fills gaps that Medicare does not cover. Your Medicare benefits continue exactly as they were.

What if I live in a state that has not expanded Medicaid?

If your state has not expanded Medicaid under the Affordable Care Act, you may still be able to get Medicaid as a senior or disabled person. States that have not expanded Medicaid for working-age adults often still have Medicaid programs for people over 65 or on disability. Contact your state Medicaid office to find out what programs are available to you.

Can I get Medicaid if I own a home?

Yes. Most states do not count your primary home as an asset for Medicaid purposes. However, if you are in a nursing home and receiving Medicaid, the state may try to recover costs from your estate after you pass away, which could affect your home. Ask your state Medicaid office about estate recovery rules in your state.

How long does Medicaid coverage last once I am approved?

Medicaid coverage is usually renewed once a year. Your state will send you a renewal form asking you to confirm your income and assets. If your situation has not changed, renewal is usually automatic. If your income or assets increase above the limit, your coverage may end, so report changes to your state office promptly.

What if I am denied Medicaid?

If you are denied, the state must send you a written notice explaining why. You have the right to request a hearing to appeal the decision. The notice will tell you how to request a hearing and the important date to do so. Many people are approved on appeal, so do not give up if you are initially denied.