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 work together, and you can be enrolled in both at the same time. People with both are called dual may be able to access or dually may be able to access. Medicare is a federal program based on age or disability; Medicaid is a joint federal and state program based on income and assets. The programs have different rules, different coverage, and different costs — so having both usually means lower out-of-pocket expenses than having either one alone.

Whether you can have both depends on whether you meet the rules for each program separately. You do not have to choose one. If you are 65 or older, or under 65 and receiving Social Security Disability Insurance (SSDI), you are already in Medicare. If you also have low enough income and assets for your state's Medicaid program, you can be in Medicaid too. The two programs coordinate their payments, so Medicaid often covers what Medicare does not.

Key Takeaways

  • Dual may be able to access means you are enrolled in both Medicare and Medicaid at the same time, and this is allowed under federal law.
  • You must meet the income and asset limits for your state's Medicaid program separately from Medicare; having Medicare does not automatically make you Medicaid-may be able to access.
  • When you have both, Medicare is the primary payer for most services, and Medicaid covers costs Medicare does not pay, including copayments, coinsurance, and deductibles.
  • Your state determines Medicaid income and asset limits, so dual may be able to access rules vary by where you live.
  • You can have both Original Medicare and Medicaid, or Medicare Advantage and Medicaid, but the coordination works differently in each case.

How Medicare and Medicaid coordinate when you have both

When you have both programs, Medicare pays first for services it covers. Medicaid then pays some or all of what Medicare did not cover — including your Medicare premiums, deductibles, and copayments. This is called cost-sharing, and it is one of the main reasons dual may be able to access people have lower out-of-pocket costs.

The order matters. If a doctor or hospital bills Medicare first and Medicare denies the claim, Medicaid will not automatically pay it. You or your provider must make sure the claim goes to Medicare first. Some providers know this rule; others do not. If you receive a bill you think Medicaid should cover, contact your Medicaid office to ask whether Medicare should have paid first.

Medicaid coverage varies by state, so what Medicaid pays after Medicare also varies. Some states cover all of your Medicare premiums and cost-sharing; others cover part of it. A few states have limits on how much Medicaid will pay toward your Medicare costs in a month or year. Your state Medicaid office can tell you what your state covers.

Income and asset limits for dual may be able to access

To be dual may be able to access, you must meet two separate income tests: one for Medicare (which has no income limit) and one for Medicaid (which does). Medicare may be able to access is based on age or disability, not income. Medicaid may be able to access is based on income and assets, and the limits are set by your state.

Each state sets its own Medicaid income limit for people over 65. Some states use the federal poverty level; others set it higher. As of 2024, the federal poverty level for a single person is about $1,600 per month, but your state may allow more. Some states also count certain income differently — for example, some exclude a portion of Social Security income or allow deductions for medical expenses.

Asset limits also vary by state. Most states have a limit of $2,000 for a single person and $3,000 for a married couple, but some states have higher limits or no limit at all. Your home, one car, and certain personal items usually do not count toward the asset limit. Your state Medicaid office can tell you the exact limits where you live and which assets count.

Original Medicare versus Medicare Advantage with Medicaid

You can have Medicaid with either Original Medicare or Medicare Advantage, but the way they work together is different. With Original Medicare (Parts A and B), Medicaid covers your Part B premium, deductibles, and copayments. You can also add a Medigap policy, though Medicaid may pay for it instead of you buying it separately.

With Medicare Advantage, Medicaid still covers your Medicare premiums and cost-sharing, but the coordination is more complex. Medicare Advantage plans have their own networks and copayments, which may be different from Original Medicare. Medicaid will cover the copayments your Medicare Advantage plan charges, but you must use providers in the plan's network. If you use an out-of-network provider, Medicaid may not cover the cost.

Some states restrict which Medicare Advantage plans dual may be able to access people can join, or they require enrollment in special plans designed for dual may be able to access people. If you are dual may be able to access and thinking about switching from Original Medicare to Medicare Advantage, contact your state Medicaid office first to understand how it will affect your coverage.

Medicaid coverage that Medicare does not provide

Even when Medicare pays for a service, Medicaid may cover additional services that Medicare does not. For example, Medicare covers limited skilled nursing facility care, but Medicaid in many states covers longer stays. Medicare does not cover dental, vision, or hearing aids, but many state Medicaid programs do — though the coverage varies widely.

Medicaid also covers long-term care services like nursing home care and home and community-based services that Medicare does not cover at all. If you need extended nursing home care or in-home support, Medicaid may be the program that pays for it. This is one reason dual may be able to access people often have access to more services than people with Medicare alone.

The services Medicaid covers beyond Medicare depend on your state. Some states cover dental and vision for all Medicaid members; others cover them only for certain age groups. Some states have robust home and community-based services programs; others have waiting lists. Your state Medicaid office can tell you what services are available to you.

How to learn about you may have access to for both programs

If you are already on Medicare, you can contact your state Medicaid office to ask about Medicaid may be able to access. You will need to provide proof of your income and assets. The income documents usually include recent pay stubs, Social Security statements, or bank statements. Asset documents include bank account statements and property records.

Your state Medicaid office is run by your state health or human services department. You can find the contact information on your state's Medicaid website or by calling 211, which is a free referral line that connects you to local programs. Some states allow you to explore online; others require you to explore in person or by mail.

If you are not yet on Medicare but think you might be may be able to access for Medicaid, you can explore for Medicaid first. When you turn 65 or become may be able to access for SSDI, you will be enrolled in Medicare automatically if you are a U.S. citizen or permanent resident. You can then have both programs at the same time.

What happens to your coverage if your income or assets change

If your income or assets increase above your state's Medicaid limit, you will lose Medicaid coverage. You will still have Medicare, but you will no longer have Medicaid to help pay your premiums and cost-sharing. If your income or assets decrease, you may become may be able to access for Medicaid again.

You are responsible for reporting changes in income or assets to your state Medicaid office. Most states have a important date — often 10 days — to report changes. If you do not report a change and you were not supposed to be on Medicaid, you may have to repay benefits you received. Some states have programs that help people keep Medicaid coverage even if their income rises slightly, but these vary by state.

If you receive a notice that your Medicaid is ending, you have the right to request a hearing to challenge the decision. You can also ask your state Medicaid office about programs that might help you stay may be able to access, such as work incentives or medical expense deductions.

Frequently Asked Questions

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

No. Having Medicare does not automatically enroll you in Medicaid, and you do not have to explore for Medicaid if you do not want to. However, if you meet your state's income and asset limits, explore for Medicaid can lower your out-of-pocket costs because Medicaid will help pay your Medicare premiums and cost-sharing.

Will having Medicaid affect my Medicare benefits?

No. Medicaid does not change what Medicare covers or how Medicare works. Medicaid only helps pay costs that Medicare does not cover. You will still have the same Medicare benefits and the same access to Medicare providers.

What if I move to a different state?

Medicaid rules are different in every state, so your may be able to access and coverage may change if you move. You will need to explore for Medicaid in your new state. Your Medicare coverage will continue, but your Medicaid coverage will end when you move unless you explore in the new state before your current coverage ends.

Can I have Medicare Advantage and Medicaid together?

Yes, but you must use providers in your Medicare Advantage plan's network. Medicaid will cover your plan's copayments and deductibles, but if you go out of network, Medicaid may not pay. Some states have special Medicare Advantage plans for dual may be able to access people, so ask your state Medicaid office which plans are available to you.

Does Medicaid pay my Medicare Part D prescription drug premium?

Yes, in most states. Medicaid covers your Part D premium and cost-sharing, including copayments for prescriptions. Some states also cover prescriptions that Part D does not, though this varies. Contact your state Medicaid office to confirm what prescription coverage you have.