You can have both Medicaid and Medicare at the same time, and most people do

When you turn 65 and become may be able to access for Medicare, your Medicaid does not automatically stop. In fact, the two programs work together. Medicare becomes your primary insurance — it covers hospital stays, doctor visits, and prescription drugs. Medicaid then covers costs Medicare does not pay, like copayments, coinsurance, and deductibles. People who have both are called dual may be able to access.

The key point: you do not lose Medicaid just because you have Medicare. But you do need to take action to keep it. If you do nothing after Medicare starts, your state will review your income and resources to see if you still meet Medicaid's rules. Many people do. Some do not — and that is when coverage can end.

Key Takeaways

  • Medicare and Medicaid are separate programs that work together; having Medicare does not end your Medicaid.
  • Your state will review your Medicaid status after you turn 65, using Medicare's income and resource limits, which are usually higher than the limits for younger people.
  • If your income or resources are above your state's Medicaid limit for seniors, you will lose Medicaid coverage — but you can still buy a Medigap or Medicare Advantage plan.
  • If you delay Medicare enrollment past 65, you may face a permanent penalty on your premiums, so sign up even if you plan to keep working.
  • Your state's Medicaid rules for seniors vary, so contact your state Medicaid office or 1-800-MEDICARE to learn what applies where you live.

How your income and resources are counted after you turn 65

When you reach 65, your state switches you to the Medicaid rules for seniors and people with disabilities. These rules are different from the rules for working-age adults. Most states use a higher income limit for seniors — often around $900 to $1,100 per month, though this varies by state. Your resources (savings, investments, property other than your home) are also counted, with a limit that is usually around $2,000 for one person.

The income counted includes Social Security, pensions, wages if you still work, and some other sources. Not all income counts the same way. For example, some states do not count the first $20 of monthly income, or they use special rules for certain types of earnings. Your state Medicaid office can tell you exactly how your income will be counted.

If your income and resources fall within your state's limits, you keep Medicaid. If they exceed the limits, Medicaid ends. This happens even though you now have Medicare. The two programs have separate rules, and meeting one does not mean you meet the other.

What to do if your income is too high for Medicaid

If your income exceeds your state's Medicaid limit for seniors, you have other options to cover the gaps Medicare leaves. The most common choice is a Medigap policy (also called Supplement insurance). Medigap is sold by private insurance companies and covers many of the costs Medicare does not — copayments, coinsurance, and deductibles. You buy it yourself, and the cost depends on your age, health, and which plan you choose.

Another option is a Medicare Advantage plan (Part C). These are managed care plans sold by private insurers that include hospital, doctor, and prescription drug coverage all in one. They often have lower premiums than Medigap, but they limit which doctors you can see and may require referrals. Some Medicare Advantage plans also include dental, vision, or hearing coverage.

A third option is to stay on Original Medicare (Parts A and B) and buy a separate prescription drug plan (Part D). This costs less upfront but leaves you responsible for deductibles and coinsurance. You can compare plans and costs on Medicare.gov or by calling 1-800-MEDICARE.

When to enroll in Medicare to avoid penalties

You should enroll in Medicare during your Initial Enrollment Period, which is the seven-month window that starts three months before the month you turn 65. If you miss this window, you may face a permanent penalty on your Part B and Part D premiums — a surcharge that stays with you for life.

The penalty is 10 percent of the Part B premium for each full year you delayed, and 1 percent of the Part D premium for each month you delayed. These penalties do not go away, even if you enroll later. The only exception is if you were covered by a group health plan through your own job or your spouse's job — in that case, you have a grace period after that coverage ends.

Even if you are still working and think you do not need Medicare yet, enroll anyway. You can delay using it, but enrolling on time protects you from penalties and ensures you have coverage if something changes.

How to keep Medicaid while you have Medicare

To keep Medicaid after you turn 65, you need to stay within your state's income and resource limits. If your income is close to the limit, watch for changes. A raise, a new pension, or a change in Social Security can push you over. If your income increases, report it to your state Medicaid office right away — do not wait for them to find out.

Some states have special programs for people who are just over the Medicaid income limit. Medicare Savings Programs (MSPs) help pay your Medicare premiums, deductibles, and coinsurance if your income is slightly above the Medicaid limit. Each state runs its own MSP, and the income limits are higher than regular Medicaid. You can ask your state Medicaid office whether you may have access to.

Keep your Medicaid office informed of any changes in your situation — income, resources, living situation, or household members. Medicaid reviews your case regularly, and staying in touch helps prevent surprises.

State-by-state differences in Medicaid for seniors

Medicaid rules for seniors are not the same everywhere. Some states are more generous with income limits; others are stricter. Some states count resources differently or have special programs for people over 65. A few states have expanded Medicaid to cover more working-age adults, but the rules for seniors are set by federal law and do not change as much.

Because the rules vary, the only way to know what applies to you is to contact your state Medicaid office directly. You can find your state office through Medicaid.gov, or you can call 1-800-MEDICARE and ask for a referral. Have your Social Security number and income information ready when you call.

What happens if you lose Medicaid after turning 65

If your state determines that your income or resources are too high for Medicaid, you will receive a notice explaining why and when coverage ends. You will have a chance to appeal the decision if you disagree. The notice will also tell you about other coverage options, including Medigap and Medicare Advantage plans.

Losing Medicaid does not mean you lose Medicare. Medicare continues regardless. But you will need to find another way to cover the costs Medicare does not pay. If you lose Medicaid because of income, you may be able to buy a Medigap policy without waiting or paying a higher premium — some states have rules that protect you in this situation. Ask your state Medicaid office about your options before coverage ends.

Frequently Asked Questions

Do I have to do anything to keep both Medicare and Medicaid?

You do not have to do anything to start having both — your state will automatically review your Medicaid status after you enroll in Medicare. But you should report any changes in income or resources to your state Medicaid office right away. If your situation changes and you do not report it, you could lose coverage unexpectedly.

What if I work and earn income after 65?

Wages you earn count toward your Medicaid income limit. If you work and your total income (wages plus Social Security, pensions, and other sources) exceeds your state's limit, you will lose Medicaid. Some states have special rules for earned income or allow you to set aside some earnings, so ask your state Medicaid office how your wages will be counted.

Can I get Medicaid back if I lose it?

Yes, if your income or resources drop back below the limit, you can reapply. You will need to report the change to your state Medicaid office and provide proof of your new income. Medicaid can usually restart within one to two months of approval.

What is the difference between Medigap and Medicare Advantage?

Medigap is a supplement that works with Original Medicare and covers costs Medicare does not pay. Medicare Advantage is an alternative to Original Medicare that includes hospital, doctor, and drug coverage in one plan, usually with lower premiums but more restrictions on which doctors you can see.

Will I lose Medicare if I lose Medicaid?

No. Medicare and Medicaid are separate programs. Losing Medicaid does not affect Medicare. You will still have hospital and doctor coverage through Medicare, but you will need to find another way to pay for the costs Medicare does not cover.