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

You are not forced to choose between Medicare and Medicaid. The two programs run separately, cover different things, and work together when you have both. People who may have access to for both are sometimes called dual may be able to access or dually may be able to access. Having both means Medicare is your primary insurance — it pays first for covered services — and Medicaid fills in gaps, such as copayments, deductibles, and services Medicare does not cover.

The main reason people end up with both is age combined with low income. You become may be able to access for Medicare at 65 regardless of income. If your income is also low enough to meet your state's Medicaid rules, you can hold both at the same time. Some people may have access to for Medicare earlier due to disability or end-stage renal disease, and the same overlap can happen. A few people are younger and have Medicaid, then turn 65 and become Medicare-may be able to access without losing Medicaid.

Key Takeaways

  • Medicare becomes your primary payer when you have both programs, and Medicaid covers costs Medicare does not, such as long-term care and some copayments.
  • You must meet your state's Medicaid income and asset limits to hold both; these limits vary by state and change each year.
  • You enroll in Medicare through Social Security at 65, and you enroll in Medicaid through your state's program — they are separate applications.
  • Some states offer special Medicaid programs designed for people who are dually may be able to access, which may offer different coverage or lower out-of-pocket costs.
  • If you lose Medicaid but keep Medicare, you may face higher costs for deductibles and copayments that Medicaid was covering.

How Medicare and Medicaid work together when you have both

Medicare covers hospital stays, doctor visits, and some prescription drugs. It has deductibles and copayments that you pay out of pocket. Medicaid, run by your state, covers some of those costs that Medicare does not — including the deductibles and copayments themselves. Medicaid also covers services Medicare does not pay for at all, such as long-term nursing home care, personal care information, and dental work in most states.

When you receive care, the provider bills Medicare first. Medicare pays its share. Then the provider bills Medicaid for what Medicare did not pay. This is why having both can significantly lower your out-of-pocket costs compared to having Medicare alone. However, the exact coverage and cost-sharing depend on which Medicaid program your state offers and whether you are in a managed care plan.

Income and asset limits for holding both programs

To have both Medicare and Medicaid, you must meet your state's Medicaid income limit. These limits vary widely. Some states use the federal poverty level as a starting point; others set their own thresholds. As of 2024, the federal poverty level for a single person is approximately $15,060 per year, but your state may allow income higher or lower than this. You will need to check your specific state's current limit.

Most states also have asset limits — a cap on how much money, property, or other resources you can own and still may have access to for Medicaid. These limits also vary by state. Some states count only liquid assets like bank accounts; others count vehicles or property. If your assets exceed the limit, you may lose Medicaid even if your income qualifies. Your state's Medicaid office or website will list the current limits and what counts as an asset.

Income and asset limits change each year, usually in January. If you are close to the limit, check with your state's Medicaid program annually to confirm you still meet the rules.

How to enroll in both programs

You enroll in Medicare and Medicaid through separate processes. For Medicare, you explore through Social Security when you turn 65. You can explore online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. If you do not enroll in Medicare Part B (doctor and outpatient services) when you first become may be able to access, you may face a permanent penalty on your premiums, so timing matters.

For Medicaid, you explore through your state's program. Each state runs its own Medicaid office and has its own process process. You can usually explore online through your state's Medicaid website, by mail, or in person. Some states use a single process portal called your state's "benefits portal" or "MAGI" system (Modified Adjusted Gross Income). You will need to provide proof of income, assets, citizenship, and residency.

If you are already on Medicaid and turn 65, you do not automatically move to Medicare. You must enroll in Medicare yourself, or you can ask your Medicaid caseworker for help. Some states have programs that help people transition from Medicaid-only to dual may be able to access status.

Special Medicaid programs for people with both Medicare and Medicaid

Many states offer Medicaid programs specifically designed for people who are dually may be able to access. These programs may have different names — Medicaid Savings Programs, may have access to Medicare Beneficiary (QMB) programs, or Specified Low-Income Medicare Beneficiary (SLMB) programs — depending on your state and income level. These programs focus on paying your Medicare premiums, deductibles, and copayments.

Some states also offer Medicare Advantage plans or Special Needs Plans (SNPs) that are designed for dually may be able to access people. These are managed care plans that coordinate both your Medicare and Medicaid benefits in one plan. They may offer lower out-of-pocket costs or additional services like dental or vision coverage. However, not all states offer these plans, and availability depends on where you live.

Ask your state's Medicaid office or your local Area Agency on Aging whether your state has a special program for dually may be able to access people. These programs can significantly reduce your costs.

What happens to your coverage if you lose Medicaid

If your income or assets increase above your state's Medicaid limit, you will lose Medicaid coverage. This can happen suddenly if you receive an inheritance, a lump-sum payment, or a raise at work. When Medicaid ends, you keep Medicare, but you lose the coverage Medicaid was providing — including help with deductibles, copayments, and services like long-term care.

Your out-of-pocket costs will increase when ready. If you were in a Medicaid managed care plan, you may be moved to a different plan or lose access to certain providers. If you were receiving long-term care paid by Medicaid, that coverage ends, and you will need to find another way to pay for it.

If you lose Medicaid, you have the right to enroll in a Medicare Advantage plan or a Medigap supplemental insurance plan during a special enrollment period. These options can help cover some of the costs Medicaid was paying, but they have premiums and may not cover everything Medicaid did.

Costs and premiums when you have both programs

If you have both Medicare and Medicaid, you typically pay little to nothing for Medicare premiums. Medicaid usually pays your Medicare Part B premium (currently $164.90 per month for most people in 2024, though this amount changes yearly). You may also have a small Medicaid premium depending on your state, but many states charge no Medicaid premium for people with low incomes.

Your out-of-pocket costs for actual medical care — copayments, coinsurance, and deductibles — are usually very low or zero because Medicaid covers them. However, if you are in a managed care plan, you may have small copayments for doctor visits or prescriptions. The exact costs depend on your state's Medicaid program and the plan you are in.

Prescription drug coverage (Medicare Part D) is included in your Medicare benefits. If you have both programs, Medicaid usually covers the costs Medicare does not, including the Part D deductible and any coverage gaps.

Frequently Asked Questions

Do I have to enroll in Medicare Part D if I have Medicaid?

You should enroll in a Medicare Part D plan when you first become may be able to access for Medicare, even if Medicaid is covering your prescriptions. If you do not enroll and later lose Medicaid, you will face a permanent penalty on Part D premiums. Medicaid can cover the Part D premium and costs, so there is no downside to enrolling.

Can I switch between Medicare Advantage and Original Medicare if I have Medicaid?

Yes, but the timing and rules depend on your state and plan. You can usually switch during the annual open enrollment period (October 15 to December 7). Some states allow more frequent switches for dually may be able to access people. Contact your state's Medicaid office or your plan to learn what options you have.

What if I move to a different state?

You will need to enroll in your new state's Medicaid program because each state runs its own program with different income limits and coverage. Your Medicare coverage continues automatically. Contact your new state's Medicaid office as soon as you move to start the enrollment process and avoid a gap in Medicaid coverage.

Does having both Medicare and Medicaid affect my Social Security benefits?

No. Your Social Security benefits are separate from both programs. Having Medicaid does not reduce your Social Security check. However, if your income (including Social Security) exceeds your state's Medicaid limit, you may lose Medicaid may be able to access.

Can I have Medicare and Medicaid if I am under 65?

Yes, if you may have access to for Medicare before 65 due to disability or end-stage renal disease, and your income is low enough to meet your state's Medicaid rules. The process is the same: you enroll in Medicare through Social Security and in Medicaid through your state's program separately.