Yes, you can have both Medicaid and Medicare

You can hold both Medicaid and Medicare at the same time. In fact, millions of people do. When you have both programs, Medicare is your primary insurance — it pays first for covered services — and Medicaid acts as a secondary payer, covering some costs that Medicare does not.

People with both programs are sometimes called "dual may be able to access" or "dually may be able to access." This usually happens when you turn 65 and become may be able to access for Medicare based on age or work history, but your income and assets are low enough that you also may have access to for Medicaid. It can also happen if you are younger but receive Medicare because of a disability or end-stage renal disease.

Key Takeaways

  • Medicare becomes your primary payer when you have both programs, meaning it covers its share of costs first.
  • Medicaid covers some of Medicare's deductibles, copayments, and coinsurance, which can lower your out-of-pocket costs significantly.
  • You must meet your state's income and asset limits for Medicaid even if you already have Medicare.
  • Enrollment in both programs happens separately — Medicare through Social Security and Medicaid through your state.
  • Some states offer special Medicaid programs designed specifically for people who have both Medicare and Medicaid.

How the two programs work together

When you have both programs, the order of payment matters. Medicare processes your claim first and pays its portion of the bill. Then the claim goes to Medicaid, which reviews what Medicare did not pay and may cover some or all of the remaining balance, depending on what service you received and what your state's Medicaid program covers.

This coordination can save you money. For example, if you see a doctor and the visit costs $100, Medicare might pay $80 (after you meet your deductible). Medicaid may then pay some or all of the $20 copayment you would otherwise owe. The exact amount depends on your state's rules and the type of service.

However, Medicaid will not pay more than what Medicare allows for a service, even if the provider charges more. This is called the "Medicare allowable amount," and it is the maximum either program will consider.

Income and asset limits you must meet

Having Medicare does not automatically make you Medicaid-may be able to access. You still must meet your state's income and asset limits. These limits vary by state and change each year. Some states are more generous than others — a person with the same income might may have access to in one state but not in another.

Your state Medicaid office will look at your monthly income (including Social Security, pensions, and other sources) and your countable assets (savings, investments, and property, though your home and one vehicle usually do not count). If both fall below your state's threshold, you can have Medicaid alongside Medicare.

If your income or assets are slightly above the limit, you may still may have access to under a "spend-down" program, where you use some of your income or assets for medical or long-term care costs, bringing you below the threshold. Rules for spend-downs differ by state.

How to enroll in both programs

Enrollment happens through two separate processes. You do not enroll in both at once.

For Medicare, you enroll through Social Security when you turn 65 (or earlier if you receive disability benefits). You can enroll 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 when you first become may be able to access, you may face a permanent penalty on your premiums.

For Medicaid, you explore through your state's Medicaid office or through your state's health insurance marketplace. Each state runs its own program, so the process process and what you need to bring varies. You can find your state Medicaid office through medicaid.gov. Some states let you explore online, by mail, or in person.

Special Medicaid programs for people with Medicare

Some states offer Medicaid programs designed specifically for people who have both Medicare and Medicaid. These programs may have different rules or cover additional services.

One example is the may have access to Medicare Beneficiary (QMB) program, which helps pay your Medicare premiums, deductibles, and copayments if your income is very low. Another is the Specified Low-Income Medicare Beneficiary (SLMB) program, which helps pay your Medicare Part B premium. These are federal programs, but your state Medicaid office handles enrollment.

Some states also run their own programs that wrap around Medicare coverage. Your state Medicaid office can tell you which programs you may be able to use based on your income and situation.

What happens to your coverage if your income changes

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. Your Medicare coverage continues because it is based on age or disability, not income. You would then have only Medicare, and you would be responsible for all copayments, deductibles, and other out-of-pocket costs that Medicaid was covering.

If your income drops back below the limit later, you can reapply for Medicaid. Some states let you report income changes online or by phone, while others require you to submit a new process. Contact your state Medicaid office to find out how to report changes.

If your income rises only slightly, you may still may have access to under your state's spend-down rules or under a special program like QMB or SLMB, which have higher income limits than regular Medicaid.

Costs you still pay with both programs

Even with both programs, you may have some out-of-pocket costs. Medicare has deductibles and copayments, and Medicaid does not always cover all of them. The amount you pay depends on what service you receive and what your state's Medicaid program covers.

For example, Medicare Part D (prescription drug coverage) has a deductible, and Medicaid may or may not cover it depending on your state. Long-term care costs are another area where coverage varies — Medicare covers very little, and Medicaid coverage depends on your state and whether you meet the medical and financial requirements.

Some services that neither program covers at all, such as dental work, hearing aids, or vision care, will still be your responsibility. A few states offer limited Medicaid coverage for these services, but most do not.

Frequently Asked Questions

Do I have to choose between Medicaid and Medicare?

No. You can have both at the same time. You do not choose one or the other. If you meet the requirements for both programs, you can be enrolled in both, and they will work together to cover your medical costs.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not reduce or change your Medicare benefits. Medicare remains your primary coverage. Medicaid straightforward helps pay some of the costs that Medicare does not cover, such as copayments and deductibles.

What if I turn 65 and get Medicare but do not think I may have access to for Medicaid?

You should still explore. Income and asset limits vary by state, and some states have programs like QMB or SLMB with higher limits than regular Medicaid. Your state Medicaid office can tell you whether you may have access to for any program. You can explore online, by mail, or in person.

Can I lose Medicare if my Medicaid is canceled?

No. Medicare and Medicaid are separate programs. If you lose Medicaid because your income rose, your Medicare coverage continues. You would then have only Medicare and be responsible for all copayments and deductibles yourself.

Do I need to enroll in both programs at the same time?

No. You enroll in Medicare through Social Security and Medicaid through your state separately. You can enroll in one before the other. However, if you are turning 65, it is important to enroll in Medicare on time to avoid penalties, even if you are not yet sure about Medicaid.