Yes, you can have both Medicare and Medicaid, and millions of people do

You are not forced to choose one or the other. Medicare and Medicaid are separate programs run by different parts of the federal government, and they can overlap. If you meet the rules for both, you can be enrolled in both at the same time. The two programs work together — Medicare is your primary insurance, and Medicaid fills in gaps that Medicare does not cover, like copayments, deductibles, and some long-term care costs.

People who have both are sometimes called dual may be able to access or dually may be able to access. This status is common among people over 65 with low income, people under 65 who are disabled and have low income, and people who need extended nursing home or home care. Having both programs can lower your out-of-pocket costs significantly compared to having Medicare alone.

Key Takeaways

  • You can enroll in both Medicare and Medicaid if you meet the income and other rules for each program separately.
  • Medicare pays first for covered services, and Medicaid covers some costs Medicare does not, 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 are over 65 or disabled and have low income, you may may have access to for both without having to do anything extra — some states enroll you automatically.

How Medicare and Medicaid work together when you have both

When you have both programs, Medicare is your primary payer. That means Medicare processes your claim first and pays its share of the bill. Medicaid then becomes your secondary payer and covers some of what Medicare did not pay — typically your copayments, coinsurance, and deductibles.

For example, if you see a doctor and Medicare covers 80 percent of the visit, you would normally owe 20 percent. If you have Medicaid as well, Medicaid may pay all or part of that 20 percent, depending on your state's rules. Medicaid can also cover services that Medicare does not cover at all, such as dental care, vision care, and long-term nursing home stays (after Medicare's limited coverage ends).

The two programs do not duplicate each other. Medicaid will not pay a bill that Medicare has already paid in full. Instead, Medicaid fills the gaps — the costs that Medicare leaves you responsible for.

Income and resource limits vary by state

To have both programs, you must meet the income and resource rules for both Medicare and Medicaid. Medicare has no income limit — anyone 65 or older, or anyone under 65 who is disabled or has end-stage renal disease, can enroll. Medicaid, however, does have income limits, and they differ from state to state.

Some states use the federal poverty level as their Medicaid income limit. Others set it higher. A few states set it lower. Your state's limit depends on the Medicaid category you fall into — whether you are over 65, disabled, blind, or a parent of a dependent child. You can have both programs only if your income is low enough to meet your state's Medicaid limit.

Medicaid also has resource limits in most states — a cap on how much money and property you can own and still may have access to. Medicare has no resource limit. If your resources are above your state's Medicaid limit, you cannot have Medicaid, even if your income is low enough.

Who typically qualifies for both programs

The most common group with both programs is people 65 and older with low income. If you are over 65, you are automatically enrolled in Medicare Part A (hospital insurance) when you turn 65. If your income is also low enough for your state's Medicaid program, you can have Medicaid at the same time.

People under 65 who are disabled can also have both. If you receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you are enrolled in Medicare after 24 months of SSDI or when ready upon SSI enrollment. If your income remains low, you may also may have access to for Medicaid.

People who need long-term nursing home care or home-based services often have both programs. Medicare covers only a limited stay in a skilled nursing facility (up to 100 days under certain conditions). Medicaid covers extended nursing home stays and many home care services for people with low income and resources. Having both programs helps pay for the costs Medicare does not cover.

How to learn about you may have access to in your state

Because Medicaid rules vary by state, the income and resource limits that explore to you depend on where you live. You can contact your state Medicaid office directly to ask whether you may have access to for both programs. Your state Medicaid office can tell you the exact income and resource limits for your situation and help you understand whether you meet them.

You can also call 1-800-MEDICARE to speak with someone who can explain Medicare rules and direct you to your state Medicaid office. Some states have programs specifically for people 65 and older with low income — programs with names like "Medicaid for the Elderly" or "Aged and Disabled" — that make it easier to may have access to for both.

If you are already on Medicare and think you might may have access to for Medicaid, do not wait to contact your state office. Some people are enrolled in Medicaid automatically once they meet the income rules, but others must submit information to be considered. The sooner you reach out, the sooner you may start receiving Medicaid benefits.

What happens to your coverage if your income changes

If your income goes up, you may lose Medicaid coverage while keeping Medicare. Medicare has no income limit, so you will stay enrolled. Medicaid will end if your income exceeds your state's limit. You should report income changes to your state Medicaid office so your coverage is updated correctly.

If your income drops back down later, you can reapply for Medicaid. Some states have rules that let you regain Medicaid quickly if you lose it due to income, but the process varies. The key is to report changes promptly so there are no gaps in your coverage or unexpected bills.

Frequently Asked Questions

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

Not always. If you are 65 or older and your income is low enough, some states enroll you in Medicaid automatically once you are on Medicare. Other states require you to submit an process. Contact your state Medicaid office to find out what is required in your state.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not change what Medicare covers or how Medicare works. Medicaid straightforward helps pay costs that Medicare leaves you responsible for. Your Medicare benefits stay the same whether or not you have Medicaid.

What if I live in a state that did not expand Medicaid?

Some states have not expanded their Medicaid programs, which can make it harder to may have access to if you are under 65 and not disabled. However, if you are 65 or older, you may still may have access to for Medicaid in your state even if it did not expand. Contact your state Medicaid office to learn the income limits that explore to you.

Can I have both Medicare and Medicaid if I am working?

Yes, if your income from work is low enough to meet your state's Medicaid limit. Some states have special rules that let people who are disabled and working keep Medicaid even if their income is slightly above the normal limit. Ask your state Medicaid office about work incentive programs.

What should I do if I think I may have access to for both programs?

Contact your state Medicaid office or call 1-800-MEDICARE to learn the income and resource limits in your state. Have information about your income, resources, and household size ready. If you may have access to, the office will explain what documents you need to submit and how long the process takes.