What It Means to Be Eligible for Both Medicare and Medicaid

Dual may be able to access means you may have access to for both Medicare and Medicaid at the same time

If you are dually may be able to access, the federal government (through Medicare) and your state (through Medicaid) both cover some of your medical costs. You are not choosing between them — you have both. Medicare is your primary insurance, which means it pays first. Medicaid then covers some costs Medicare does not pay, like copayments, coinsurance, and services Medicare does not cover at all.

Dual may be able to access usually happens when you turn 65 and become may be able to access for Medicare, but your income is low enough that you also may have access to for Medicaid. Some people become dually may be able to access earlier if they receive Supplemental Security Income (SSI) or have a disability that qualifies them for both programs. The rules vary by state because each state runs its own Medicaid program.

Being dually may be able to access can lower your out-of-pocket costs significantly. Medicaid may pay your Medicare premiums, deductibles, and copays — the exact coverage depends on which Medicaid category you fall into and where you live.

Key Takeaways

Dual may be able to access means Medicare is your primary insurance and Medicaid covers gaps, reducing what you pay out of pocket for medical care.
You usually become dually may be able to access at age 65 when you turn 65 and may have access to for Medicare, if your income is low enough for Medicaid in your state.
Medicaid can pay your Medicare premiums, deductibles, and copayments, but the exact coverage depends on your state and which Medicaid category you are in.
You must be enrolled in Medicare Part A and Part B to be dually may be able to access; Medicaid will not cover the gap if you have only Part A.
Your state Medicaid office determines your dual may be able to access status, not Medicare, so the rules and benefits you receive depend on where you live.

How dual may be able to access works with your two insurance plans

When you have both Medicare and Medicaid, the two programs work together in a specific order. Medicare always pays first — this is called the "primary payer" rule. After Medicare pays its share, Medicaid reviews the bill and pays what Medicare did not cover, up to what Medicaid allows.

Here is a concrete example: you see a doctor and the bill is $150. Medicare approves $100 of that visit and pays 80 percent, which is $80. You would normally owe the remaining $20 copayment. If you are dually may be able to access, Medicaid steps in and pays that $20 copayment for you. You pay nothing.

This coordination happens automatically once both programs know about each other. When you enroll in Medicare, you should tell Medicare that you also have Medicaid. When you explore for Medicaid, tell them you have Medicare. The programs will then coordinate your coverage.

The three main categories of dual may be able to access

Not all dually may be able to access people have the same Medicaid coverage. Your category depends on your income, assets, and whether you receive SSI. Each category has different rules about what Medicaid will pay.

may have access to Medicare Beneficiaries (QMB) have the most help. Medicaid pays your Medicare Part B premium, deductible, and coinsurance. Your income must be between 100 and 120 percent of the federal poverty level, and your assets must be below a certain limit (which varies by state, but is usually around $7,500 for an individual). In 2024, this means a single person earning roughly $1,550 to $1,860 per month could may have access to, though the exact amount changes yearly and by state.

Specified Low-Income Medicare Beneficiaries (SLMB) receive less help than QMB. Medicaid pays only your Medicare Part B premium. Your income must be between 120 and 135 percent of the federal poverty level. This category exists for people whose income is slightly too high for QMB but still low enough to need help with premiums.

may have access to Individuals (QI) is the smallest program. Medicaid pays your Medicare Part B premium only, and only if you do not may have access to for QMB or SLMB. Your income must be between 135 and 175 percent of the federal poverty level. This program has limited funding in most states, so not everyone who meets the income requirement can enroll.

A fourth category, may have access to Disabled and Working Individuals (QDWI), covers people under 65 who are working but have a disability and may have access to for Medicare. This is less common but follows similar rules to the others.

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

Your income and assets determine whether you may have access to for dual may be able to access and which category you fall into. Income includes Social Security, pensions, wages, and some other sources. Assets include bank accounts, stocks, and real estate (though your home usually does not count).

The federal poverty level changes every year, and each state can set its own limits within federal guidelines. This means the exact dollar amount that qualifies you varies by state and changes annually. For example, in 2024, the federal poverty level for a single person is around $1,550 per month, but your state may use a higher percentage of that for Medicaid purposes.

To find out the current income and asset limits in your state, contact your state Medicaid office directly. You can also call 211 (a free referral service) and ask for your state Medicaid program. They will tell you the exact limits and whether you meet them based on your situation.

Some states have "spend-down" programs that let you become may be able to access for Medicaid by using your income to pay for medical care. If your income is slightly above the limit, you may be able to set aside money for medical expenses and become may be able to access. Ask your state Medicaid office whether this option exists where you live.

How to learn about you are dually may be able to access

You do not automatically become dually may be able to access just because you turn 65 and enroll in Medicare. You must also explore for Medicaid through your state. Medicaid does not enroll you automatically, even if you meet the income requirements.

Start by contacting your state Medicaid office. You can find it by searching "[your state] Medicaid" online, or call 211 and ask for the Medicaid office in your area. Have your Social Security number, birth date, income information, and asset information ready. Some states let you explore online, by mail, or in person.

When you explore, tell them you have Medicare. This helps them determine which dual may be able to access category you might fit into. If you are approved, Medicaid will send you a card or letter confirming your coverage. Keep this document — you will need to show it to doctors and hospitals.

If you are already receiving SSI (Supplemental Security Income), you may be automatically enrolled in Medicaid in your state. Check with your state Medicaid office to confirm whether you are already covered.

What services Medicaid covers that Medicare does not

Beyond paying Medicare's copayments and deductibles, Medicaid covers some services that Medicare does not cover at all. These vary by state, but commonly include long-term care in a nursing home, personal care information at home, dental care, and vision care.

If you need a nursing home stay that will last more than 100 days, Medicare stops paying after day 100. Medicaid can then take over and pay for your continued stay, as long as you meet Medicaid's asset and income limits. This is one of the biggest financial protections dual may be able to access offers.

Medicaid also covers some prescription drugs that Medicare does not, though both programs have drug formularies (lists of covered medications) that change yearly. If you take a medication that Medicare does not cover, ask your doctor whether Medicaid in your state covers it.

The specific services covered depend on your state's Medicaid program. Ask your state Medicaid office for a list of services covered under your category of dual may be able to access.

What to tell your doctor and hospital about dual coverage

When you go to a doctor or hospital, bring both your Medicare card and your Medicaid card. Tell the front desk staff that you have both. The provider's billing office will then bill Medicare first, and Medicaid second.

Some providers are not familiar with dual may be able to access and may not bill Medicaid correctly. If you receive a bill you think Medicaid should have paid, contact your state Medicaid office and ask them to review it. You can also ask the provider's billing office to resubmit the claim to Medicaid.

If a provider tells you they do not accept Medicaid, you have the right to ask whether they accept your specific Medicaid plan. Some providers accept Medicare but not Medicaid, or vice versa. If this happens, ask your state Medicaid office for a list of providers in your area who accept both.

Questions to ask your doctor and state Medicaid office

Before your next appointment, write down these questions and bring them with you or call your state Medicaid office:

Do you accept both Medicare and Medicaid? If not, which one do you accept?
What is my copayment or coinsurance for this visit under my Medicaid plan?
If I need a prescription, will you check whether my Medicaid plan covers it before you write it?
If I need a specialist or hospital care, do I need a referral from my primary care doctor?
What should I do if I receive a bill I think Medicaid should have paid?

Frequently Asked Questions

Can I have dual may be able to access if I am under 65?

Yes, if you receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) and your income is low enough. You become may be able to access for Medicare after receiving SSDI for two years. If you also meet your state's Medicaid income limits, you can be dually may be able to access before age 65.

What happens to my dual may be able to access if my income goes up?

If your income rises above your state's limit for your category, you may lose Medicaid coverage. However, you will keep Medicare. Contact your state Medicaid office right away if your income changes, because they may move you to a different category with higher income limits, or you may need to reapply later if your income drops again.

Do I have to enroll in a Medicare Advantage plan if I am dually may be able to access?

You can choose either Original Medicare (Part A and Part B) or a Medicare Advantage plan. However, some Medicare Advantage plans work better with Medicaid than others. Ask your state Medicaid office which plans coordinate well with Medicaid in your area before you enroll.

Will I lose Medicaid if I move to a different state?

You will need to reapply for Medicaid in your new state, because each state runs its own program with different income limits and covered services. Contact your new state's Medicaid office as soon as you move to start the process. Your Medicare coverage will continue automatically.

What if my state denies my Medicaid process?

You have the right to appeal. Your state Medicaid office will send you a letter explaining why you were denied and how to request a hearing. You can also contact your state's ombudsman office (a free service that helps resolve disputes) or a legal aid organization for help with your appeal.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.