Yes, you can have both Medicare and Medicaid

You can hold both Medicare and Medicaid at the same time. People who do are called dual may be able to access or dually may be able to access. This happens most often when someone turns 65 and becomes may be able to access for Medicare while still meeting the income and asset limits for Medicaid in their state.

When you have both programs, they work together to cover your medical costs. Medicare is your primary insurance, meaning it pays first. Medicaid then covers some or all of what Medicare does not pay, depending on your state's rules and your specific situation.

Being dual may be able to access can significantly reduce your out-of-pocket costs because two programs are sharing the bill. However, the exact way they coordinate depends on which state you live in and what type of Medicaid coverage you have.

Key Takeaways

  • Dual may be able to access means you have both Medicare and Medicaid at the same time, which is legal and common for people over 65 with low income.
  • Medicare pays first, and Medicaid covers some or all of the costs that Medicare does not pay, depending on your state and income level.
  • Your state determines how much Medicaid will help pay for Medicare premiums, deductibles, and copayments.
  • Some states offer special Medicaid programs designed specifically for dual may be able to access people, which may offer extra benefits like dental or vision coverage.

How Medicare and Medicaid work together

When you have both programs, the coordination is straightforward in most cases. Medicare processes your claim first and pays its share of the bill. The provider then sends the remaining balance to Medicaid, which reviews whether it will cover that amount under your state's Medicaid rules.

Medicaid will not pay more than Medicare allows for a service, and it will not pay for services Medicare says are not medically necessary. However, Medicaid can cover costs that Medicare does not, such as long-term care in a nursing home or personal care services at home.

You will still have a Medicare card and a Medicaid card. When you go to a doctor or hospital, you present both. The provider's billing office handles sending claims to both programs in the correct order.

Income and asset limits for dual may be able to access

To be dual may be able to access, you must meet both programs' requirements. You automatically may have access to for Medicare at 65 if you have worked and paid into Social Security, or if you are a spouse or dependent of someone who has. That part does not depend on income.

Medicaid may be able to access, however, depends on your income and assets, and these limits vary by state. Most states use the federal poverty level as a starting point, but many allow higher income limits for people over 65. Some states have special programs for dual may be able to access people that use higher income thresholds than regular Medicaid.

Your state Medicaid office can tell you the exact income and asset limits that explore to you. You can find your state office through the Medicaid website or by calling your local social services department.

What Medicaid covers when you have Medicare

When you are dual may be able to access, Medicaid typically covers three main things: Medicare premiums, Medicare deductibles and copayments, and services that Medicare does not cover.

For premiums, Medicaid in most states will pay your Part B premium (which covers doctor visits and outpatient care) and sometimes your Part D premium (which covers prescription drugs). Some states also help with Part A premiums, though most people do not have a Part A premium.

For cost-sharing, Medicaid covers some or all of your deductibles and copayments, depending on your state and income level. This can make a real difference if you use a lot of medical services.

For services Medicare does not cover, Medicaid may pay for nursing home care, home health aides, dental work, vision care, and hearing aids. These benefits vary significantly by state, so check with your state Medicaid program about what is available to you.

Special Medicaid programs for dual may be able to access people

Many states offer programs designed specifically for people who have both Medicare and Medicaid. These programs often have names like "Medicaid for the Elderly" or "Aged and Disabled" categories, and they may have higher income limits or offer additional benefits compared to regular Medicaid.

Some states run managed long-term care programs for dual may be able to access people, which coordinate all your medical and long-term care services through a single plan. These programs can make it easier to manage your care because one organization handles both Medicare and Medicaid services.

Other states offer Programs of All-Inclusive Care for the Elderly (PACE), which provide comprehensive medical and social services to people over 55 who are dual may be able to access and meet certain care needs. PACE programs are available in many states but not all.

Your state Medicaid office can tell you which programs exist in your area and whether you meet the requirements for each one.

How to report changes that affect your coverage

If your income, assets, or living situation changes, you must report it to both Medicare and Medicaid. Changes that matter include a significant increase or decrease in income, moving to a different state, getting married or divorced, or a change in your living arrangement.

Report changes to Medicaid through your state Medicaid office. Report changes to Medicare through Social Security or by calling Medicare directly at 1-800-MEDICARE. Do not assume one program will automatically know about the change.

Reporting changes promptly helps prevent overpayments that you might have to repay later, and it ensures you keep the coverage you are may have access to to.

What happens if you move to a different state

If you move to a different state, your Medicaid coverage ends on the last day of the month you move. Your Medicare coverage continues, but you will need to enroll in your new state's Medicaid program if you still meet the income and asset limits there.

Medicaid rules and income limits are different in every state, so you may find that you no longer may have access to in your new state, or that you may have access to for a different level of coverage. Contact your new state's Medicaid office as soon as you move to find out what you need to do.

Your Medicare coverage does not change when you move, so you do not need to do anything with Medicare itself. However, if you are in a Medicare Advantage plan or a prescription drug plan, you may need to switch plans because not all plans are available in every state.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you meet the requirements for both, you can and should have both. There is no rule that forces you to pick one. Having both typically saves you money because Medicaid helps pay for costs that Medicare does not cover.

Will Medicaid pay for Medicare premiums?

In most states, yes. Medicaid will pay your Part B premium and often your Part D premium if you are dual may be able to access and meet your state's income limits. Some states also pay Part A premiums, though most people do not have one. Your state Medicaid office can tell you exactly what premiums your state covers.

What if I lose Medicaid but still have Medicare?

You will still have Medicare coverage, but you will be responsible for paying Medicare premiums, deductibles, and copayments yourself. You can look into other ways to help cover these costs, such as a Medigap policy or a Medicare Advantage plan, though these have their own costs and rules.

Can I have Medicare Advantage and Medicaid at the same time?

Yes. If you enroll in a Medicare Advantage plan, you can still have Medicaid. However, make sure the plan you choose is available to dual may be able to access people in your state, because not all plans accept Medicaid members. Your state Medicaid office can help you find plans that work with Medicaid.

How do I know if I meet the income limit for Medicaid in my state?

Contact your state Medicaid office directly. Income limits vary widely by state and change each year. Your state office can tell you the current limit and help you understand whether your income qualifies. You can find your state office through the Medicaid website or by calling your local social services department.