Dual Coverage: How Medicare and Medicaid Work Together

What Dual Coverage Means

If you have both Medicare and Medicaid, you are called a dual may be able to access person. Medicare is your federal health insurance based on age or disability. Medicaid is a state program that helps people with low income pay for medical care. When you have both, Medicaid steps in to pay some of the costs that Medicare does not cover — like copayments, coinsurance, and deductibles.

You do not choose to become dual may be able to access. It happens automatically when you meet the income and asset limits for Medicaid in your state while also may have access to for Medicare. The two programs work together, with Medicare as your primary insurance and Medicaid as your secondary payer.

Key Takeaways

Dual may be able to access means you have both Medicare and Medicaid at the same time, and Medicaid covers costs that Medicare leaves you responsible for.
You become dual may be able to access when your income and assets fall below your state's Medicaid limits while you already have Medicare.
Your state Medicaid program determines what extra services it will cover beyond what Medicare pays, so coverage varies by where you live.
Some states offer special managed care plans called D-SNPs (Dual may be able to access Special Needs Plans) that coordinate Medicare and Medicaid benefits in one plan.
You keep your Medicare card and your Medicaid card; both programs must be used together when you receive care.

How Income and Assets Determine Dual may be able to access

To be dual may be able to access, your monthly income must be below a certain level set by your state. For 2024, the federal poverty guideline for a single person is roughly $1,500 per month, but your state may set its own limit higher or lower. You also cannot own more than a certain amount in assets — typically $2,000 for an individual, though some states allow more for people over 65.

The exact numbers change each year and differ by state. Your state Medicaid office is the only source that can tell you whether your specific income and assets may have access to you. You can find your state Medicaid office through the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE.

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

Medicaid covers the out-of-pocket costs that Medicare requires you to pay. This includes Medicare Part B premiums, Part A and Part B deductibles, and copayments or coinsurance for doctor visits, hospital stays, and other services. In many states, Medicaid also covers prescription drugs through a program called Medicare Savings Programs or Extra Help, which reduces what you pay for Part D coverage.

Beyond Medicare's gaps, your state Medicaid program may cover services that Medicare does not pay for at all. These often include dental care, vision care, hearing aids, and long-term care in a nursing home or assisted living facility. What your state covers varies widely — some states are generous, others minimal. You need to check with your state Medicaid program to know what you have.

If you live in a state that offers a D-SNP (Dual may be able to access Special Needs Plan), you may be able to join a single managed care plan that bundles both your Medicare and Medicaid benefits. This can simplify your coverage, but you must live in an area where a D-SNP operates and meet that plan's enrollment rules.

How to learn about You may have access to

Start by contacting your state Medicaid office directly. You can find the phone number through the CMS website at cms.gov or by calling 1-800-MEDICARE and asking for a referral. Have your Social Security number, income documents (recent pay stubs or tax return), and a list of your assets ready.

You can also contact a State Health Insurance information Program (SHIP), which is free and independent. SHIP counselors can tell you whether you likely may have access to and walk you through the steps to explore. Find your local SHIP at shiptalk.org or by calling 1-877-839-2675.

If you are already receiving Supplemental Security Income (SSI) or have been told you are "categorically needy," you may already be dual may be able to access without having to explore again. Call your state Medicaid office to confirm your status.

What Happens at the Doctor's Office

When you see a doctor or go to the hospital, you will present both your Medicare card and your Medicaid card. The provider bills Medicare first. Medicare pays its share, and then the provider bills Medicaid for the remaining balance. You should not owe anything out of pocket for covered services.

Some providers may not accept Medicaid, even if they accept Medicare. Before your appointment, call ahead and confirm that the provider takes both programs. If a provider refuses to bill Medicaid, you can report this to your state Medicaid office — in most states, refusing to bill Medicaid is illegal.

Staying Dual may be able to access: Income and Asset Limits

Your dual may be able to access can end if your income or assets rise above your state's limits. This can happen if you receive a raise, inherit money, or sell a home. Some states have special rules for people over 65 that allow higher asset limits or do not count a home toward your asset total.

If your income or assets change, report it to your state Medicaid office right away. Do not wait for them to discover it. Some changes may not affect your coverage, and reporting early can prevent you from owing money back later if your coverage ends retroactively.

Frequently Asked Questions

Do I have to join a D-SNP plan, or can I stay on regular Medicare?

You do not have to join a D-SNP. You can keep your original Medicare and your Medicaid card separate. D-SNPs are optional and available only in certain areas. If your state does not offer one, or if you prefer to choose your own doctors, you can stay on regular Medicare and let Medicaid cover the gaps.

What if my state Medicaid program does not cover something Medicare does not cover?

Then you will have to pay for it yourself, or go without. Medicaid coverage of services beyond Medicare varies by state. Some states cover dental and vision; others do not. Call your state Medicaid office to ask what is and is not covered before you need the service.

Can I lose my Medicaid if I work?

Working does not automatically disqualify you, but your income from work counts toward the income limit. Some states have work incentive programs that allow you to earn a certain amount without losing Medicaid. Ask your state Medicaid office whether you have a work incentive program and what the income threshold is.

Do I need to do anything to keep my dual coverage each year?

Your state Medicaid program may require you to recertify your income and assets once a year or every few years. You will receive a notice in the mail telling you when and how to recertify. If you do not respond, your Medicaid can be terminated. Keep the notice and respond by the important date.

What should I ask my doctor about my dual coverage?

Ask whether the office accepts both Medicare and Medicaid, and confirm that they will bill both programs. Ask about any services that might not be covered by either program. If you are prescribed a medication, ask whether it is covered under your Medicare Part D plan and whether Medicaid will help pay for it.

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.