You may have both Medicare and Medicaid if your income and assets fall below your state's limits and you meet age or disability requirements

People who hold both Medicare and Medicaid are called dual may be able to access. Medicare is federal health insurance for people 65 and older, or younger people with certain disabilities or end-stage renal disease. Medicaid is a joint federal-state program that covers people with low income and limited assets. You can have both at the same time if you meet the rules for each program in your state.

The main reason to have both is cost. Medicare has premiums, deductibles, and copayments. Medicaid can cover those out-of-pocket costs and also pay for services Medicare does not cover, like long-term care in a nursing home or assisted living. About 12 million Americans are dual may be able to access, and most are over 65 or have disabilities.

Your state sets the income and asset limits for Medicaid, so the threshold for being dual may be able to access varies by location. Some states are more generous than others. You do not automatically get Medicaid when you turn 65 and enroll in Medicare — you have to meet your state's Medicaid rules separately.

Key Takeaways

  • Dual may be able to access means you have both Medicare and Medicaid, which happens when you meet the income and asset limits for Medicaid in your state and also may have access to for Medicare.
  • Income limits for Medicaid vary by state and are usually between 75% and 100% of the federal poverty level, though some states have higher thresholds for older adults.
  • Medicaid covers Medicare premiums, deductibles, and copayments, plus services Medicare does not cover such as nursing home care and personal care information.
  • You must enroll in Medicare Part A and Part B to be dual may be able to access; Medicaid does not automatically cover you when you turn 65.
  • Your state Medicaid office handles the Medicaid part of your coverage, while Medicare is managed federally through Social Security or your local Social Security office.

Income and asset limits that make you dual may be able to access

To be dual may be able to access, your monthly income must fall below your state's Medicaid limit. Most states use 75% to 100% of the federal poverty level as their threshold. For 2024, the federal poverty level for a single person is about $1,145 per month, so a state at 100% would allow income up to roughly that amount. However, some states set higher limits for people over 65, and a few states allow higher income if you have high medical expenses.

Asset limits also matter. Most states allow you to own up to $2,000 in countable assets if you are single, or $3,000 if you are married. Countable assets include bank accounts, stocks, and bonds. Your home, car, and personal belongings usually do not count. Some states have higher asset limits for older adults or people with disabilities.

Your state Medicaid office will tell you the exact limits that explore to you. You can find your state office through the Medicaid website or by calling 1-800-MEDICARE to ask for a referral. Income and asset rules change, so it is worth checking every year, especially if your situation changes.

How to learn about you meet your state's rules

Start by contacting your state Medicaid office directly. You can find the phone number on your state's Medicaid website or by calling 211, which is a free helpline that connects you to local resources. Have your Social Security number, birth date, income information, and a list of your assets ready when you call.

If you are already on Medicare, you can also ask Social Security whether you may be dual may be able to access. Call 1-800-772-1213 or visit your local Social Security office. They can refer you to Medicaid or tell you how to contact your state program. Some states have special programs for people over 65 with low income, such as Medicaid Buy-In programs, which may have different rules than standard Medicaid.

You can also explore for Medicaid online in many states through your state's Medicaid portal. The process asks about your income, assets, household size, and whether you receive Medicare. Be honest about all income sources, including Social Security, pensions, and part-time work. Medicaid staff will verify your information with Social Security and other agencies.

What Medicaid covers that Medicare does not

If you are dual may be able to access, Medicaid pays your Medicare premiums, deductibles, and copayments. This alone saves many people hundreds of dollars per year. But Medicaid also covers services that Medicare does not, and this is often the bigger benefit.

Medicaid covers long-term care in a nursing home or assisted living facility, which Medicare covers only for a limited time after a hospital stay. Medicaid also pays for personal care information — help with bathing, dressing, and toileting — in your home or in a facility. Many dual may be able to access people rely on Medicaid to pay for these services because Medicare does not.

Medicaid also covers dental care, vision care, and hearing aids in most states, though the scope varies. It covers prescription drugs through Medicaid, though you may also be in Medicare's drug plan. If you are dual may be able to access, Medicaid usually pays first for services it covers, and Medicare pays second.

How being dual may be able to access affects your Medicare enrollment

You still need to enroll in Medicare Part A and Part B on time, even if you think you will be on Medicaid. If you do not enroll in Part B when you first become may be able to access at 65, you may face a permanent penalty on your premiums. The good news is that if you are on Medicaid, Medicaid will pay your Part B premium for you, so the cost is not your problem — but you still have to be enrolled.

If you are under 65 and on Medicaid because of a disability, you become may be able to access for Medicare after you have been on Social Security Disability Insurance (SSDI) for 24 months. At that point, you will be dual may be able to access automatically. You do not have to do anything; Medicare enrollment happens without a separate process.

If you are on Medicaid and turn 65, you should enroll in Medicare Part A and Part B during your Initial Enrollment Period, which is three months before, the month of, and three months after your 65th birthday. Your state Medicaid office or Social Security can help you with this step.

Managed care and dual may be able to access programs in your state

Many states require dual may be able to access people to join a managed care plan that coordinates both Medicare and Medicaid. These plans are called Medicare-Medicaid Plans or D-SNPs (Dual may be able to access Special Needs Plans). A managed care plan means you choose a health plan that handles both your Medicare and Medicaid benefits, and you usually must see doctors in that plan's network.

Some states offer programs specifically for dual may be able to access people, such as Programs of All-Inclusive Care for the Elderly (PACE). PACE provides medical care, social services, and long-term care services in one coordinated program, often at an adult day center. PACE is available in some states and not others, and it has its own enrollment process.

Ask your state Medicaid office which managed care plans or special programs are available to you. If your state requires managed care, you will receive information about your options and important date. If you do not choose a plan, your state may assign you to one automatically.

What happens to your coverage if your income or assets change

If your income or assets go above your state's limit, you may lose Medicaid but keep Medicare. This can happen if you receive a raise, inherit money, or start receiving a pension. Report changes to your state Medicaid office right away. Some states have a grace period before they remove you from Medicaid, but do not count on it.

If your income drops again, you can reapply for Medicaid. There is no penalty for losing and regaining Medicaid. However, if you lose Medicaid and later regain it, you may have a gap in coverage for services like long-term care, so it is worth trying to stay enrolled if you can.

If you receive Supplemental Security Income (SSI), your state Medicaid office will monitor your income automatically. If you receive other benefits or income, you are responsible for reporting changes. Most states allow you to report changes online, by phone, or by mail.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. You can and should have both if you meet the rules for each. Medicare and Medicaid work together — Medicaid covers costs that Medicare does not, and it pays your Medicare premiums and out-of-pocket costs. Having both is almost always better than having one alone.

What if my state did not expand Medicaid?

Some states have not expanded Medicaid to cover more low-income adults. If your state is one of them, the income limit for Medicaid may be very low — sometimes only 50% of the federal poverty level. You may still be dual may be able to access if you are over 65 or have a disability, because those groups have their own Medicaid pathways. Call your state Medicaid office to find out your state's rules.

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

Yes. If you are dual may be able to access, you can enroll in a Medicare Advantage plan, but many states require you to use a D-SNP (Dual may be able to access Special Needs Plan) instead of a regular Medicare Advantage plan. D-SNPs are designed for people with both Medicare and Medicaid. Ask your state Medicaid office which plans you can choose.

What if I live in a nursing home — does that change my dual may be able to access?

No. You can be dual may be able to access while living in a nursing home, and Medicaid will pay for your care there. However, most states require you to spend down your assets to a certain level before Medicaid pays for nursing home care. This is called the "spend-down" rule. Ask your nursing home social worker or your state Medicaid office how this works in your state.

How do I know if I should stay on Medicaid or try to get off it?

If you are dual may be able to access, staying on Medicaid almost always saves you money because it covers your Medicare costs and services Medicare does not. The only reason to leave Medicaid would be if your income rose above the limit, which would happen automatically. There is no benefit to giving up Medicaid voluntarily.