When You Have Both Medicare and Medicaid at the Same Time

How Medicare and Medicaid work together when you have both

If you have both Medicare and Medicaid, they coordinate so that each program pays its share of your medical bills — Medicare pays first for most services, then Medicaid covers what Medicare doesn't. You don't choose between them or apply to use one instead of the other. Both programs stay active at the same time, and you use both insurance cards when you see a doctor or go to the hospital. The combination is sometimes called dual coverage, and it typically means you pay less out of pocket than you would with either program alone.

This matters because Medicare alone has deductibles, copayments, and gaps in coverage — particularly for prescription drugs and long-term care. Medicaid fills those gaps. If you're under 65 and have both, it's usually because you may have access to for Medicare through disability (SSDI or SSI) and also meet your state's income and asset limits for Medicaid. The exact way they coordinate depends on which Medicaid program your state runs and what services you need.

Key Takeaways

• Medicare pays first for most medical services, and Medicaid covers the costs Medicare doesn't pay, including deductibles and copayments.
• You keep both insurance cards active and present both when you see a doctor, hospital, or pharmacy.
• Medicaid covers services Medicare doesn't, such as long-term care, dental, and vision — but only the services your state's Medicaid program includes.
• If your income or assets increase, you may lose Medicaid while keeping Medicare, so report changes to your state Medicaid office right away.
• Some states offer managed Medicaid plans that coordinate with Medicare; others use fee-for-service Medicaid, and the experience is different between them.

What happens when you have both: the payment order

When you receive medical care, Medicare is the primary payer — it processes your claim first and pays its share based on what it covers. Medicaid is the secondary payer — it receives the claim after Medicare and pays what Medicare didn't cover, up to what Medicaid allows. This means the provider bills Medicare first, Medicare sends you an explanation of benefits showing what it paid and what you owe, and then the provider (or you) sends that to Medicaid.

In practice, this usually happens automatically if your provider has both your Medicare and Medicaid information on file. You should not have to submit anything yourself. However, if a provider only has one insurance card, the claim may get stuck. Always give both your Medicare card and your Medicaid card to every provider, pharmacy, and hospital you use.

The coordination saves you money because Medicaid often covers the patient cost-sharing that Medicare requires — your deductible, copayments, and coinsurance. Without Medicaid, you would owe these amounts yourself. With Medicaid as secondary, Medicaid typically pays them so you owe nothing.

Services Medicaid covers that Medicare does not

Medicare has strict limits on what it pays for. Medicaid fills some of those gaps, but only the services your state includes in its Medicaid program. The most important difference for people under 65 is long-term care: Medicare does not pay for nursing home care, assisted living, or in-home personal care beyond a short recovery period. Medicaid does pay for these services if you meet the income and asset limits, which is why many people with disabilities rely on Medicaid to afford ongoing support.

Medicaid in most states also covers dental care, vision care (including glasses), hearing aids, and transportation to medical appointments — services Medicare does not cover or covers only in limited ways. Some states cover more: podiatry, mental health counseling, or over-the-counter items. Check your state Medicaid program's website or call your Medicaid caseworker to learn what your state covers.

The catch is that Medicaid coverage varies widely by state. A service covered in one state may not be covered in another. If you move to a different state, your Medicaid benefits will change, even though your Medicare stays the same.

How to know if you have dual coverage or if you're may be able to access

You have dual coverage if you receive a Medicaid card from your state and also have Medicare. If you're not sure, check your mail for both cards, or call your state Medicaid office and give them your Social Security number — they can tell you whether you're enrolled.

If you have Medicare but not Medicaid, you may be able to get Medicaid if your income and assets fall below your state's limits. Income limits vary by state and by which Medicaid program you might join — some states have higher limits for people with disabilities. Your state Medicaid office can tell you the exact limits and whether you meet them. You can also contact your local Area Agency on Aging or a disability services organization in your state; they often help people understand whether they may have access to.

If you have Medicaid but not yet Medicare, and you receive SSDI (Social Security Disability Insurance), you automatically become may be able to access for Medicare after you've been on SSDI for 24 months. Social Security will enroll you automatically, and you'll receive a Medicare card in the mail. You keep your Medicaid at the same time.

What to do if your income or assets change

Medicaid has income and asset limits, and if you exceed them, you lose Medicaid coverage even though you keep Medicare. This can happen if you get a raise, receive an inheritance, or have a change in household income. You must report changes to your state Medicaid office within the timeframe your state requires — usually 10 to 30 days, depending on the state.

If you don't report a change and you're no longer supposed to have Medicaid, the state may ask you to repay benefits you received while ineligible. This is called overpayment recovery, and it can be substantial. Report changes promptly to avoid this problem.

Some states have programs that let you keep Medicaid even if your income rises slightly — for example, programs for people with disabilities that allow higher income limits or that let you set aside income for work incentives. Ask your Medicaid caseworker whether your state has a program that might apply to you.

Managed Medicaid versus fee-for-service Medicaid

Some states require people with dual coverage to join a managed Medicaid plan — a health insurance plan run by a private company that contracts with Medicaid. In a managed plan, you choose a primary care doctor, get referrals for specialists, and the plan coordinates your care. Other states use fee-for-service Medicaid, where you can see any doctor who accepts Medicaid, and there's no gatekeeper or referral requirement.

If your state uses managed Medicaid, you'll receive information about which plans are available and how to choose one. You must pick a plan to stay enrolled in Medicaid. If you don't choose, your state will assign you to one. The plan works alongside your Medicare — Medicare is still primary, and the Medicaid plan covers what Medicare doesn't.

The experience is different between the two. Managed plans often have smaller networks of doctors and may require prior approval for certain services. Fee-for-service Medicaid is usually simpler — you just show your card — but you have to find doctors who accept it. Ask your state Medicaid office which model your state uses and what it means for your care.

Keeping both programs active: what you need to do

Once you have both Medicare and Medicaid, you don't have to reapply to keep them both active. However, you do have to stay on top of your Medicaid renewal. Medicaid requires you to recertify your may be able to access periodically — usually once a year, though some states do it more often. Your state will send you a form or a notice telling you when to recertify. If you miss the deadline and don't respond, you can lose Medicaid even if you still may have access to.

Set a reminder on your phone or calendar when your Medicaid renewal notice arrives. Fill it out and return it before the deadline. If you're not sure whether you still may have access to, submit the form anyway — the state will determine your may be able to access based on the information you provide.

You should also update both programs if your address, phone number, or household changes. Medicare and Medicaid use this information to contact you, and if they can't reach you, they may assume you've moved and close your case. You can update Medicare online at Medicare.gov or by calling 1-800-MEDICARE. Update Medicaid through your state Medicaid office.

Frequently Asked Questions

Do I have to pay premiums for both Medicare and Medicaid?

Most people with Medicare pay a monthly premium for Part B (doctor and outpatient services). If you have Medicaid, Medicaid usually pays this premium for you — you don't pay it yourself. Medicaid may also pay your Part D (prescription drug) premium. You typically don't pay a Medicaid premium if you're on Medicaid because of disability. Check with your state Medicaid office about what it covers.

What if a doctor won't accept Medicaid?

Some doctors don't accept Medicaid because the reimbursement rate is low. If your doctor won't accept Medicaid, you can still see them and use only Medicare, but you'll owe any copayments or coinsurance that Medicare doesn't cover — Medicaid won't pay for a service it wasn't billed for. Ask your doctor's office whether they accept Medicaid before scheduling. If they don't, you may want to find a doctor who does so you can use both programs.

Can I lose Medicare if my income goes up?

No. Medicare doesn't have income limits. You keep Medicare no matter how much money you earn. However, if your income rises above your state's Medicaid limit, you will lose Medicaid. You'll still have Medicare, but you'll owe the copayments and deductibles that Medicaid was covering. Report income changes to Medicaid right away so you know whether you're still may be able to access.

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

Your Medicare follows you to any state — it's a federal program. Your Medicaid does not. When you move, your old state's Medicaid ends, and you must apply for Medicaid in your new state. The income limits, covered services, and application process are different in every state. Contact your new state's Medicaid office as soon as you move to understand what coverage you can get there.

Do I need to do anything special at the pharmacy with both insurance cards?

Give the pharmacy both your Medicare and Medicaid cards. The pharmacy will bill Medicare first for your prescription, and if Medicare doesn't cover it or if you owe a copayment, the pharmacy will bill Medicaid. If the pharmacy only has one card on file, the claim may not process correctly. Make sure both cards are in the pharmacy's system before you pick up a prescription.