Yes, you can be enrolled in both Medicare and Medicaid simultaneously

People who may have access to for both programs are called dual may be able to access or dually may be able to access. Medicare is a federal health insurance program based primarily on age (65 and older) or disability status. Medicaid is a joint federal-state program based on income and assets. Because they use different rules, the same person can meet the requirements for both.

When you have both, Medicare is your primary insurance—it pays first for covered services. Medicaid then covers some costs that Medicare does not pay, like copayments, coinsurance, and deductibles. In some cases, Medicaid also covers services Medicare does not cover at all, such as long-term care or dental work, depending on your state's program.

Being dual may be able to access can significantly reduce your out-of-pocket costs compared to having Medicare alone, but the exact coverage depends on which Medicaid program your state offers and your specific enrollment status.

Key Takeaways

  • You can enroll in both Medicare and Medicaid if you meet the income and asset limits for Medicaid in your state while also may have access to for Medicare through age or disability.
  • Medicare pays first for covered services, and Medicaid covers many of the costs Medicare does not pay, including deductibles and copayments.
  • Medicaid coverage varies by state, so the services and costs covered depend on where you live and which Medicaid program you are in.
  • You do not need to choose between the two programs—you can and should enroll in both if you meet the requirements, as it typically lowers your total healthcare costs.

How income and asset limits work when you have both programs

Medicaid has income and asset limits that vary by state and by program type. To be dual may be able to access, your income must fall below your state's Medicaid limit, and your countable assets (savings, investments, property other than your home) must also stay under the state's threshold. These limits are much lower than most people expect—many states set the asset limit at $2,000 for an individual, though some states have higher limits for certain Medicaid programs.

Medicare itself has no income or asset limits. You may have access to for Medicare at 65 regardless of how much money you have, or earlier if you receive Social Security Disability Insurance (SSDI) or have end-stage renal disease. This is why someone can be wealthy enough to have substantial assets and still may have access to for Medicare, but would not may have access to for Medicaid.

The reverse is also possible: someone with very low income might may have access to for Medicaid but not yet be old enough for Medicare. Once they turn 65 or become disabled and receive SSDI for 24 months, they become dual may be able to access.

Different types of dual-may be able to access programs by state

States structure their Medicaid programs differently, which affects what services you receive as a dual-may be able to access person. Some states have Medicaid expansion programs that cover adults under 65 with income up to a certain percentage of the federal poverty level. Others have more limited programs for seniors and people with disabilities. A few states have special programs designed specifically for dual-may be able to access individuals.

Some states offer managed long-term care programs for dual-may be able to access people, which combine Medicare and Medicaid services into one coordinated plan. Other states use traditional fee-for-service Medicaid alongside your regular Medicare coverage. The type of program available to you depends on your state, your age, your disability status, and sometimes your income level within the Medicaid range.

Because these programs differ significantly, the amount you pay out of pocket and the services covered can vary widely depending on where you live. You can find information about your state's specific programs through your state Medicaid office or by contacting your local Area Agency on Aging.

What happens to your Medicare premiums and cost-sharing when you have Medicaid

If you are dual may be able to access, Medicaid in most states will pay your Medicare Part B premium (currently $164.90 per month in 2024, though this changes yearly). Some states also pay your Part D prescription drug premium. Medicaid typically covers your Medicare deductibles and copayments as well, which is one of the biggest financial benefits of being dual may be able to access.

However, Medicaid will not pay your Medicare Part A premium if you have worked long enough to may have access to for it without paying a premium. Part A is hospital insurance, and most people 65 and older do not pay a premium for it because they or their spouse paid Medicare taxes while working.

The exact costs Medicaid covers depend on your state's rules and which Medicaid program you are enrolled in. Some states are more generous than others. You should contact your state Medicaid office to learn what specific costs are covered under your program.

How to enroll in both programs

You do not enroll in both programs at the same time through a single process. Instead, you enroll in Medicare first, usually when you turn 65 or become may be able to access through disability. You can enroll through Social Security, online at Medicare.gov, or by calling 1-800-MEDICARE.

After you have Medicare, you then explore for Medicaid through your state. Each state has its own process process and important date rules. Some states have continuous open enrollment, meaning you can explore any time. Others have specific enrollment periods. You can find your state Medicaid office contact information through the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE and asking for a referral.

When you explore for Medicaid, you will need to provide proof of income, assets, citizenship, and residency. You will also need to report that you already have Medicare. The Medicaid office will use this information to determine whether you meet the income and asset limits for your state's program.

Services Medicaid covers that Medicare does not

One major advantage of being dual may be able to access is that Medicaid often covers services Medicare does not pay for. Long-term care in a nursing home is the most significant example—Medicare covers only short-term skilled nursing care after a hospital stay, while Medicaid covers extended nursing home stays if you meet the financial requirements. Medicaid also typically covers personal care services, adult day care, and home and community-based services that help you stay in your home rather than move to a facility.

Medicaid in most states also covers dental work, vision care, and hearing aids—services Medicare does not cover. Prescription drugs are covered under Medicare Part D, but Medicaid may cover additional drugs or have lower copayments than your Part D plan. Transportation to medical appointments is another service Medicaid often covers that Medicare does not.

The specific services vary by state, so you should ask your state Medicaid office which services are covered under your program. This information is important when deciding whether to enroll in certain Medicare supplemental plans or prescription drug plans.

What to do if your income or assets change

If your income increases above your state's Medicaid limit, you will lose Medicaid coverage. You will still have Medicare, but you will lose the cost-sharing help Medicaid was providing. If your income drops again, you can reapply for Medicaid. Some states have special rules that allow you to keep Medicaid for a short period even if your income temporarily exceeds the limit, but this varies.

If your assets increase above the limit, the same rule applies—you may lose Medicaid may be able to access. However, certain assets do not count toward the limit, such as your primary home (up to a certain equity value in some states), one vehicle, and personal belongings. You should ask your state Medicaid office which assets are excluded so you understand whether a change in your situation affects your coverage.

You are required to report changes in income or assets to your Medicaid office. The timing and method for reporting vary by state, but most states allow you to report changes online, by phone, or by mail. If you do not report changes and your circumstances no longer meet Medicaid requirements, you could be asked to repay benefits you received while ineligible.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you meet the requirements for both, you should enroll in both. Having both programs together typically costs you less out of pocket than having Medicare alone, because Medicaid covers many of the costs Medicare does not pay.

What is the income limit to be dual may be able to access?

The income limit varies by state and by Medicaid program type. Most states set the limit between 74% and 100% of the federal poverty level for seniors and people with disabilities, though some states have higher limits. You can find your state's specific limit by contacting your state Medicaid office or visiting the CMS website.

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

Yes. If you are dual may be able to access, you can enroll in a Medicare Advantage plan instead of Original Medicare. Some Medicare Advantage plans are specifically designed for dual-may be able to access people and may offer additional benefits like dental or vision coverage. Check with your state Medicaid office to see which Medicare Advantage plans work with your state's Medicaid program.

What happens to my Medicaid if I move to a different state?

Your Medicaid coverage ends when you move, because each state runs its own program with different rules and limits. You will need to explore for Medicaid in your new state. Your Medicare coverage continues regardless of where you live. You should explore for Medicaid in your new state before your old coverage ends to avoid a gap.

Will Medicaid pay back my Medicare premiums if I was not enrolled in Medicaid when I should have been?

Some states have rules that allow Medicaid to pay back premiums for a limited time in the past, but this varies. Contact your state Medicaid office to ask whether retroactive payment is possible in your situation.