What It Means to Have Both Medicare and Medicaid

Some people hold both Medicare and Medicaid at the same time. This happens when a person meets the income and asset limits for Medicaid and is old enough or disabled enough to may have access to for Medicare. The two programs work together: Medicare is the federal insurance program for people 65 and older (or some younger people with disabilities), while Medicaid is a joint federal-state program for people with low income. When you have both, you are sometimes called dual may be able to access.

Having both programs does not mean you get double coverage or that one cancels out the other. Instead, they divide the work. Medicare is your primary insurance and pays first. Medicaid then covers some of what Medicare does not pay — copayments, coinsurance, and deductibles. In some cases, Medicaid also covers services that Medicare does not cover at all, such as long-term care in a nursing home.

This arrangement exists because many seniors and disabled people live on very small incomes. A person on Social Security alone may have too little money to afford Medicare's out-of-pocket costs, even though they are may have access to to Medicare. Medicaid steps in to make healthcare affordable for them.

Key Takeaways

  • You can have both Medicare and Medicaid if you are 65 or older (or disabled and on Medicare) and your income and assets fall below your state's Medicaid limits.
  • Medicare pays first, and Medicaid covers many of the costs Medicare leaves behind, such as copayments and deductibles.
  • Each state sets its own Medicaid income limits, so whether you may have access to depends partly on where you live.
  • If you have both programs, you will have a Medicare card and a Medicaid card, and you must show both when you receive care.
  • Some states offer special Medicaid programs designed specifically for people who are dual may be able to access, with different rules than regular Medicaid.

How Income and Asset Limits Work

To have both Medicare and Medicaid, you must first be may have access to to Medicare (usually by being 65 or older, or by receiving Social Security Disability Insurance). Then you must meet your state's Medicaid income and asset rules. These limits vary by state and change each year.

Income includes Social Security, pensions, wages, and interest from savings. Some income is not counted — for example, the first $20 of most unearned income is excluded, and some states exclude a portion of your home's value. Assets include bank accounts, stocks, and property you own, though your primary home and one vehicle are usually not counted.

Because Medicaid rules differ by state, a person who qualifies in one state might not may have access to in another. If you move, you will need to reapply for Medicaid in your new state. Your Medicare coverage moves with you, but Medicaid does not.

The Different Types of Dual may be able to access Programs

Not all dual may be able to access people are in the same situation. Some states have created special Medicaid programs for people who have both Medicare and Medicaid. These programs are sometimes called Medicare Savings Programs or may have access to Medicare Beneficiary (QMB) programs.

A Medicare Savings Program pays some or all of your Medicare premiums, deductibles, and copayments. To be in one, your income must be between 100 and 200 percent of the federal poverty level (the exact threshold depends on which program). These programs are run by Medicaid but are narrower than full Medicaid — they do not cover long-term care or other services that full Medicaid covers.

Other dual may be able to access people are in full Medicaid, which covers more services. The difference matters because full Medicaid can pay for nursing home care, home health aides, and other long-term services that Medicare Savings Programs do not cover. Which program you are in depends on your income and your state's rules.

How the Two Programs Pay Together

When you have both Medicare and Medicaid, the order of payment is fixed. Medicare always pays first, as the primary payer. Medicaid then pays what Medicare does not cover — but only up to what Medicaid would have paid if Medicare were not involved.

Here is a concrete example: suppose you see a doctor and the bill is $100. Medicare approves $80 of that bill and pays 80 percent, which is $64. You owe a $16 copayment. If you have Medicaid, Medicaid will pay that $16 copayment. The doctor may not bill you for the remaining $20 (the amount Medicare did not approve), because Medicaid rules protect you from balance billing.

For hospital stays and other inpatient care, the coordination is similar. Medicare pays its share first, and Medicaid covers the copayments and coinsurance that Medicare leaves behind. This means your out-of-pocket costs are much lower than they would be with Medicare alone.

What Services Are Covered When You Have Both

Your coverage depends on whether you are in a Medicare Savings Program or full Medicaid. If you are in a Medicare Savings Program, you have Medicare coverage plus help paying Medicare costs. You do not have coverage for services Medicare does not cover.

If you are in full Medicaid, you have a much wider range of coverage. In addition to Medicare services, full Medicaid covers long-term care in a nursing home (if you meet medical and financial requirements), home health aides, personal care services, and some dental and vision care. The exact services vary by state.

One important note: if you need long-term care, full Medicaid is what pays for it. Medicare does not cover nursing home care or assisted living. If you are only in a Medicare Savings Program and later need a nursing home, you would have to spend down your assets to Medicaid limits before Medicaid would cover the cost.

How to Know If You Have Both Programs

If you have both Medicare and Medicaid, you will receive two separate cards in the mail: a Medicare card and a Medicaid card. Your Medicare card shows your Medicare number. Your Medicaid card shows your Medicaid number and your state's name.

When you go to the doctor or hospital, bring both cards. The provider's office will need to know about both programs so they can bill correctly. If you are unsure whether you have Medicaid, you can call your state Medicaid office or visit your state's Medicaid website. You can also call 1-800-MEDICARE to ask about your Medicare coverage and whether you might be may be able to access for Medicaid.

Some people have Medicare but do not realize they also may have access to for Medicaid. If your income is low, it is worth checking. Many seniors do not know that Medicaid can help pay their Medicare costs.

What to Ask Your Doctor and When to Seek Help

If you have both programs, tell your healthcare providers about both. Ask them to confirm they accept both Medicare and Medicaid before you receive care. Some providers accept Medicare but not Medicaid, or vice versa. Knowing this ahead of time prevents billing problems later.

If you receive a bill you think is wrong, ask the provider's billing office to explain it. Tell them you have both Medicare and Medicaid. If the bill is still unclear, you can contact your state Medicaid office or call 1-800-MEDICARE for help understanding the charges.

If your income or assets change, report the change to your state Medicaid office. Medicaid may be able to access is based on current income, so if you receive a raise, inheritance, or other change in finances, your coverage might change. It is better to report the change yourself than to have Medicaid discover it and ask for repayment later.

Frequently Asked Questions

Can I have Medicare without Medicaid?

Yes. Many people have Medicare alone because their income is too high to may have access to for Medicaid. You become may have access to to Medicare at 65 regardless of income. Medicaid is separate and requires meeting low-income limits.

If I have both programs, do I pay Medicare premiums?

You still owe Medicare Part B premiums, but if you are in a Medicare Savings Program, Medicaid will pay them for you. If you are in full Medicaid, Medicaid also covers the premiums. You should not have to pay them out of pocket.

What happens to my Medicaid if I move to another state?

Your Medicaid coverage ends when you move. You must explore for Medicaid in your new state. Your Medicare coverage continues automatically. explore for Medicaid in your new state as soon as you move so there is no gap in coverage.

Does having Medicaid affect my Medicare benefits?

No. Medicaid does not reduce or change your Medicare benefits. It straightforward helps pay the costs that Medicare does not cover. You receive the same Medicare services whether or not you have Medicaid.

How do I know if I may have access to for Medicaid in my state?

Contact your state Medicaid office directly. You can find the phone number on your state's Medicaid website or by calling 1-800-MEDICARE and asking for a referral. They will tell you the income and asset limits for your state and whether you may have access to.