The Basic Rule: Income and Assets Matter Most

You can hold both Medicare and Medicaid at the same time. The people who do are called dual may be able to access or dually may be able to access. Medicare is federal health insurance based on age or disability; Medicaid is a joint federal-state program based on income and assets. You do not have to choose one or the other — you can meet the rules for both.

The main path to dual coverage is having low enough income and assets to meet your state's Medicaid rules while also being 65 or older, or disabled, or having end-stage renal disease (which makes you Medicare-may be able to access). Most people who are dual may be able to access are over 65 and have limited savings.

Each state sets its own Medicaid income and asset limits, so the threshold that qualifies you in one state may not in another. Your state Medicaid office is the only source that can tell you whether your specific income and assets meet the current rules.

Key Takeaways

  • You become dual may be able to access when you meet Medicare rules (age 65, disability, or end-stage renal disease) and your income and assets fall below your state's Medicaid limits.
  • Medicaid income limits vary by state and change yearly, so you must check with your state Medicaid office to know whether you may have access to.
  • If you are already on Medicare, you can contact your state Medicaid office to ask about Medicaid coverage; you do not need to wait for a specific enrollment period.
  • Dual coverage means Medicare pays first for most services, and Medicaid covers some costs Medicare does not, including long-term care and dental.
  • Your state may have a special Medicaid program for people over 65 with low income, sometimes called a "buy-in" or "spend-down" program.

How Income Limits Work and Why They Vary by State

Medicaid has a federal floor — a minimum income level below which all states must cover you — but most states set their own higher limits. For 2024, the federal minimum for a single person is roughly 75 percent of the federal poverty line, though this shifts yearly. Some states cover people at 100 percent of poverty or higher; others stay closer to the federal floor.

Your state Medicaid office publishes its current income limit on its website or can tell you over the phone. Income includes Social Security, pensions, wages, and some other sources, but the rules for what counts and what does not vary. For example, some states exclude a portion of your income before comparing it to the limit.

Asset limits also vary. Most states have a limit of $2,000 to $3,000 for a single person, but some are higher or lower. Assets include savings, stocks, and property you own, though your home and one car are usually not counted. If you are married and only one spouse is explore for Medicaid, the rules for counting the other spouse's assets are different and more complex.

Three Common Paths to Dual Coverage

Path 1: You turn 65 and enroll in Medicare, then explore for Medicaid. Once you have Medicare, you can contact your state Medicaid office at any time to ask about Medicaid coverage. You do not have to wait for an open enrollment period. If your income and assets meet the state limit, you can be added to Medicaid within weeks. This is the most straightforward route for people who have always had low income.

Path 2: You are on disability and already have Medicare, and your income drops below Medicaid limits. If you receive Social Security Disability Insurance (SSDI) and your income is low enough, you may already be on Medicaid in your state. If not, you can contact your state Medicaid office to ask. Some states automatically enroll people on SSDI into Medicaid; others require you to request it.

Path 3: You spend down your assets to meet Medicaid limits. If your income is low but your assets are too high, you may be able to "spend down" by using savings for medical care, home repairs, or other allowed expenses. Some states let you set aside money in a special account (called a pooled trust or ABLE account) to reduce your countable assets. Your state Medicaid office can explain whether this option exists in your state and how it works.

What Medicaid Covers That Medicare Does Not

When you have both, Medicare is your primary payer — it covers hospital stays, doctor visits, and some outpatient care first. Medicaid then covers some of the costs Medicare leaves behind, including copayments, coinsurance, and deductibles. This is called cost-sharing.

More importantly, Medicaid covers services Medicare does not cover at all. Long-term care in a nursing home or assisted living is the biggest one — Medicare covers only short-term skilled nursing care after a hospital stay, while Medicaid covers long-term custodial care if you meet income and asset rules. Medicaid also covers dental care, vision care, hearing aids, and transportation to medical appointments in most states, none of which Medicare covers.

Because of these differences, dual coverage is often much more complete than Medicare alone, especially for people with chronic conditions or who may need long-term care later.

How to learn about You may have access to in Your State

Contact your state Medicaid office directly. You can find the phone number and website through the Centers for Medicare & Medicaid Services (CMS) at medicaid.gov, which has a link to each state's program. When you call, have your Social Security number, birth date, income information (recent pay stubs or benefit statements), and a list of your assets ready.

Some states also have a State Health Insurance information Program (SHIP) that can walk you through the process for free. SHIP counselors know your state's rules and can help you understand whether you may have access to. You can find your local SHIP through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116.

If you are already receiving Medicare, you can also ask your Medicare plan or your doctor's office for a referral to your state Medicaid office. Some medical offices have staff who help people with Medicaid questions.

Special Programs for People Over 65 with Low Income

Some states run programs specifically for people over 65 who have income slightly above the regular Medicaid limit. These programs go by different names — Medicaid Buy-In, Aged and Disabled Waiver, or Spend-Down Program — but they all work similarly: you pay a small monthly premium or share of your income, and Medicaid covers the rest.

These programs exist because some states recognized that people just above the income cutoff still struggle to pay for care. If you are told you earn too much for regular Medicaid, ask your state Medicaid office whether one of these programs exists and whether you might may have access to. The income limit for these programs is often 150 to 200 percent of the federal poverty line, much higher than regular Medicaid.

Not all states have these programs, and the names and rules differ widely. Your state Medicaid office is the only source that can tell you whether your state has one and whether you may have access to.

What Happens to Your Coverage If Your Income or Assets Change

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. You will keep Medicare, but you will no longer have Medicaid to help pay your costs. Some states allow you to report changes right away; others check your income once a year. Ask your state Medicaid office how often they verify income and what you should do if your situation changes.

If your income drops again, you can reapply for Medicaid at any time. There is no waiting period or penalty for losing and regaining coverage.

If you receive a large inheritance, gift, or settlement, your assets may rise above the limit. Some states have a grace period before they count new assets; others count them when ready. If you think a change in your finances might affect your coverage, contact your state Medicaid office before the change happens so you understand the rules.

Frequently Asked Questions

Do I have to be on Medicare to get Medicaid?

No. You can be on Medicaid alone if you are under 65 and have low income and assets, even if you are not disabled or do not may have access to for Medicare. But if you are 65 or older, you are usually required to enroll in Medicare Part A (hospital insurance) to be on Medicaid. Some states have exceptions for people who refuse Medicare, but most do not.

If I am on Medicare already, do I have to reapply to get Medicaid?

You do not have to wait for anything. Contact your state Medicaid office and ask to explore. You can do this at any time of year. Bring proof of your income and assets, and the office will tell you within weeks whether you may have access to.

What if my state's Medicaid limit is too low for me to may have access to?

Ask your state Medicaid office about special programs for people over 65 or disabled people with slightly higher income limits. Some states have "buy-in" or "spend-down" programs. If your state does not, you may be able to set aside money in a trust or special account to lower your countable assets. A legal aid office or elder law attorney in your area can explain your options.

Will I lose my Medicare if I explore for Medicaid?

No. Medicare and Medicaid are separate programs. explore for Medicaid does not change your Medicare coverage. If you are approved for Medicaid, you will have both at the same time.

Can I choose which program pays for my care?

No. Medicare always pays first if you have both. Medicaid pays second, covering some of the costs Medicare does not. You cannot ask Medicaid to pay first or choose to use only Medicare. This order is set by federal law.