How Medicaid Covers Medicare Costs

Yes, Medicaid can pay some or all of your Medicare premiums, depending on which Medicaid program you're in and your income level. In most states, if you have both Medicare and Medicaid—a situation called "dual may be able to access"—Medicaid will cover your Part B premium (the monthly charge for doctor visits and outpatient care). Some programs also cover Part D premiums (prescription drug coverage) and the costs Medicare doesn't pay, like copays and deductibles.

The key is that you must be enrolled in both programs at the same time. Medicaid doesn't retroactively pay Medicare bills from before you were on Medicaid, and you have to meet your state's income and asset limits for Medicaid. The exact coverage depends on which of four Medicaid programs you fall into—each has different rules about what it pays.

Key Takeaways

  • Medicaid pays Medicare Part B premiums for most people who have both Medicare and Medicaid, but only if you're currently enrolled in Medicaid.
  • Your state's Medicaid program determines what else it covers—Part D premiums, copays, deductibles, and coinsurance amounts vary by state and program type.
  • You must meet your state's income and asset limits to stay on Medicaid; exceeding them will end your Medicaid coverage and stop premium payments.
  • The four dual-may be able to access Medicaid programs (QMB, SLMB, QI, and QDWI) each cover different costs, and you can only be in one at a time.
  • If you're not yet on Medicaid, you can contact your state Medicaid office or call 211 to learn whether you meet the income threshold.

The Four Medicaid Programs That Pay Medicare Costs

Medicaid has four separate programs designed specifically for people with Medicare. Each one covers different costs and has different income limits. Your state determines which program you're placed in based on your income and whether you're already on Medicare.

QMB (may have access to Medicare Beneficiary) is the broadest program. It covers your Part B premium, Part A premium (if you have to pay one), and all copays, coinsurance, and deductibles that Medicare doesn't cover. To be in QMB, your income must be at or below 100% of the federal poverty level. In 2024, that's roughly $1,415 per month for a single person, though your state may use a slightly different figure.

SLMB (Specified Low-Income Medicare Beneficiary) covers only your Part B premium. Your income can be up to 120% of the federal poverty level—roughly $1,698 per month for a single person. You still pay copays and deductibles yourself, but Medicaid handles the monthly premium.

QI (may have access to Individual) also covers only your Part B premium, but the income limit is higher: up to 135% of poverty level, or about $1,911 per month. However, QI programs have limited funding in many states and may have waiting lists. Some states run out of money partway through the year and stop accepting new people until the next fiscal year.

QDWI (may have access to Disabled and Working Individual) is for people under 65 who are working but have a disability. It covers your Part A premium only, not Part B. Income limits are higher than the other programs—up to 200% of poverty level in most states.

Income and Asset Limits That Affect Your Coverage

Medicaid programs have strict income and asset limits. If your income or assets exceed the limit for your state, you lose Medicaid coverage entirely, which means Medicaid stops paying your Medicare premiums the month after you're disenrolled.

Income limits vary slightly by state because some states use a higher percentage of the federal poverty level than others. Most states use the federal poverty level directly, but a few use a state-specific standard. Your state Medicaid office can tell you the exact number for your situation. Income includes Social Security, pensions, wages, and some other sources—but not all income counts the same way.

Asset limits also vary by state. Some states have no asset limit at all for these programs, while others cap your savings, investments, and property (excluding your home and car) at $2,000 to $4,000 for a single person. If you're married, the limit is usually higher. You'll need to report your assets when you explore and again if your state asks you to recertify your Medicaid status.

How to Find Out Which Program You're In

Your state Medicaid office assigned you to one of the four programs when you were enrolled. You can find out which one by calling your state Medicaid office directly or by looking at your Medicaid card or approval letter—it usually lists the program name or code.

If you don't have that information, call your state's Medicaid customer service line. You can find the number on your Medicaid card, or search online for "[your state] Medicaid phone number." Have your Social Security number and date of birth ready. They can tell you which program you're in, what it covers, and what your income limit is.

You can also call 211 (a free referral service) and ask them to help you contact your state Medicaid office. They can also tell you whether you might be on Medicaid at all, based on your income and age.

What Happens If Your Income Changes

If your income rises above your program's limit, you'll lose Medicaid coverage. Your state will send you a notice before they disenroll you, usually giving you at least 10 days' notice. After that date, Medicaid stops paying your Medicare premiums, and you become responsible for the full amount.

Some income changes don't count toward the limit. For example, a one-time payment (like a tax refund or inheritance) usually doesn't affect your Medicaid status. But ongoing income—a raise, a new job, or increased Social Security—does. If you're unsure whether a specific income change will affect you, ask your state Medicaid office before it happens, not after.

If your income drops back below the limit, you can reapply for Medicaid. The process usually takes 30 to 45 days. During that time, you're responsible for your Medicare premiums, so contact your state Medicaid office as soon as your income changes to start the process.

Part D Prescription Drug Coverage and Medicaid

Medicaid's role in Part D (prescription drug coverage) is more limited than with Part B premiums. Most Medicaid programs don't pay your Part D premium directly. However, if you're on Medicaid and have Part D, Medicaid may cover the costs that Part D doesn't—such as copays for drugs or the gap in coverage called the "donut hole."

Some states have programs that help pay Part D premiums for people with low income, but these are separate from the four main Medicaid programs. Your state Medicaid office can tell you whether such a program exists in your state and whether you meet the income requirements.

If you don't have Part D and you're on Medicaid, you're not required to enroll in it. Medicaid will cover your prescription drugs instead. However, if you drop Part D and later want to rejoin, you may face a penalty, so talk to your state Medicaid office before making that decision.

Frequently Asked Questions

What if I'm on Medicare but not yet on Medicaid?

Contact your state Medicaid office to learn whether your income and assets meet the limit for one of the four programs. You can also call 211 and ask for a referral to your state Medicaid office. If you do meet the limit, you can explore right away. Medicaid will only pay premiums from the month you're approved onward, not for months before you applied.

Can Medicaid pay back Medicare premiums I already paid?

No. Medicaid pays only for premiums owed during the months you're enrolled in Medicaid. If you paid Medicare premiums before Medicaid approved you, those payments are yours to keep—Medicaid won't reimburse them. This is why it's important to explore as soon as you think you might be on Medicaid.

What if I live in a state that didn't expand Medicaid?

Even in states that didn't expand Medicaid to working-age adults, the four programs for Medicare beneficiaries still exist. These programs are federally required, so they're available everywhere. However, income limits may be lower in your state. Call your state Medicaid office to find out what the limits are where you live.

Do I have to report changes to my income?

Yes. Most states require you to report income changes within 10 days. Some states ask you to recertify your Medicaid status once a year. If you don't report changes and your income exceeds the limit, Medicaid can disenroll you and ask you to repay benefits you received while ineligible. Check your Medicaid approval letter or call your state office to learn your state's reporting rules.

What if I'm married and my spouse is on Medicare but I'm not?

Your income is usually counted together for Medicaid purposes, even if only one of you is on Medicare. However, some states have rules that allow you to set aside part of your income for the spouse who isn't on Medicaid. Ask your state Medicaid office how they count household income in your situation.