When You Have Both Medicare and Medicaid: How the Two Programs Work Together

What dual may be able to access means and why it matters

If you have both Medicare and Medicaid at the same time, you are dually may be able to access. This happens most often when you are 65 or older and your income is low enough for Medicaid, or when you are younger but receive Social Security Disability Insurance (SSDI) and also may have access to for Medicaid based on income or assets.

When you have both programs, they do not work separately — they coordinate. Medicare is your primary insurance, meaning it pays first. Medicaid steps in after Medicare pays its share, covering costs Medicare does not fully cover: copayments, coinsurance, and sometimes services Medicare does not include at all. This coordination can significantly reduce what you pay out of pocket.

The catch is that having both programs requires you to understand which one pays for what, and you may need to take specific steps to make sure they are properly coordinated. Some people with dual may be able to access do not realize they have Medicaid at all, or they do not know how to use it alongside Medicare.

Key Takeaways

• Medicare pays first when you have both programs; Medicaid covers what Medicare does not, including copayments and coinsurance.
• You become dually may be able to access most commonly at age 65 when you turn on Medicare, or when you receive SSDI and your income falls below your state's Medicaid limit.
• Your state Medicaid program must know you have Medicare, and your Medicare providers must know you have Medicaid, for the coordination to work correctly.
• Some states offer special programs for people with dual may be able to access that coordinate benefits automatically and may offer additional services like dental or vision care.
• You do not need to do anything to "activate" the coordination — it happens automatically once both programs have your information — but you should verify both programs know about each other.

How Medicare and Medicaid coordinate when you have both

When you are dually may be able to access, the order of payment is fixed: Medicare always pays its share first, based on what it covers and what you owe. Then Medicaid looks at what Medicare did not pay and decides whether to cover the remainder.

Here is a concrete example. You go to your doctor and the visit costs $100. Medicare covers 80 percent of the approved amount (let's say $80), leaving you with a $20 copayment. If you have Medicaid, it can pay that $20 copayment, so you pay nothing. If Medicare does not cover a service at all — say, routine dental work — Medicaid may cover it if your state's Medicaid program includes that service.

This coordination only works if both programs have current information about you. Your Medicare providers need to know you have Medicaid so they can bill Medicaid for what Medicare does not cover. Your state Medicaid program needs to know you have Medicare so it does not try to pay first. If either program is missing this information, you may end up paying costs that should have been covered.

How you become dually may be able to access

The most common path to dual may be able to access is turning 65 and enrolling in Medicare while your income remains low enough for Medicaid. When you turn 65, you become may be able to access for Medicare based on age, regardless of income. If your income is below your state's Medicaid limit for seniors (usually around $900 to $1,100 per month, though this varies), you can also have Medicaid.

A second path is receiving SSDI before age 65. After you have received SSDI for 24 months, you automatically move to Medicare. If your income from SSDI is low enough, you may also may have access to for Medicaid based on your state's rules for working-age adults with disabilities.

A third, less common path is Supplemental Security Income (SSI). If you receive SSI, you automatically may have access to for Medicaid in most states. SSI is a needs-based program for people 65 and older, blind, or disabled with very low income and assets.

Your state Medicaid program will usually contact you when you become may be able to access, but you should not assume they know about your Medicare enrollment. Contact your state Medicaid office to confirm they have your Medicare information on file.

What you need to do to set up coordination

You do not need to file a separate form or take special action to make Medicare and Medicaid coordinate — the coordination happens automatically once both programs know about you. However, you should take steps to make sure both programs have accurate information.

First, confirm that your state Medicaid program knows you have Medicare. Call your state Medicaid office (the number is on your Medicaid card, or you can find it through your state's Medicaid website) and tell them your Medicare number. They will add it to your file. This is important because some states use your Medicare enrollment status to determine which Medicaid benefits you receive.

Second, make sure your Medicare providers know you have Medicaid. When you see a doctor or go to a hospital, bring both your Medicare card and your Medicaid card. Give the office staff both card numbers. Ask them to note in your file that you have Medicaid. This ensures they will bill Medicaid for any costs Medicare does not cover.

Third, if your state offers a special program for people with dual may be able to access (some states call these "Medicaid for the Elderly, Blind, and Disabled" or similar names), ask whether you should enroll. These programs sometimes offer additional benefits or automatic coordination that makes things simpler.

What Medicaid covers when you have Medicare

When you have both programs, Medicaid covers three main categories of costs: Medicare copayments and coinsurance, Medicare premiums (though this is rare), and services that Medicare does not cover at all.

The copayments and coinsurance are the most common. Medicare Part B (doctor visits) has a copayment of $0 to $50 per visit depending on the service. Medicare Part A (hospital stays) has a deductible of around $1,600 per hospital stay (this amount changes yearly). Medicaid can pay these amounts so you do not have to.

Services Medicare does not cover vary by state. Some states' Medicaid programs cover dental care, vision care, hearing aids, or transportation to medical appointments — services that Medicare does not include. Your state Medicaid program's website or your Medicaid caseworker can tell you what your state covers beyond what Medicare does.

One important limit: Medicaid will not pay more than Medicare allows for a service. If Medicare approves $80 for a doctor visit and you owe a $20 copayment, Medicaid can pay that $20. But Medicaid cannot pay for services Medicare has decided it will not cover at all, except for the specific services your state has chosen to add to its Medicaid program.

Special programs and managed care for people with dual may be able to access

Some states operate special programs designed specifically for people with dual may be able to access. These programs coordinate Medicare and Medicaid benefits automatically and sometimes offer additional services. The names and details vary widely by state — some call them "Dual may be able to access Special Needs Plans" (D-SNPs), others use different names entirely.

These programs typically work through Medicare Advantage plans (an alternative to Original Medicare) that are designed to work alongside Medicaid. When you enroll in one of these plans, the plan handles the coordination for you, and you may receive extra benefits like dental or vision care that neither Medicare nor standard Medicaid would cover alone.

Not every state offers these programs, and not every person with dual may be able to access can enroll in them. To find out whether your state has a special program and whether you can join, contact your state Medicaid office or call Medicare at 1-800-MEDICARE. They can tell you what options exist in your area.

What to do if you think you should have Medicaid but do not

If you have Medicare and believe your income is low enough for Medicaid but you have not received a Medicaid card, contact your state Medicaid office. You can find the phone number on your state's Medicaid website or by calling 211 (a free referral line in most areas).

When you call, have your Social Security number, Medicare number, and recent income information ready. Income limits for seniors with Medicare vary by state but typically range from $900 to $1,100 per month. Some states count only your own income; others count a spouse's income too. Your state Medicaid office can tell you whether you meet the limit.

If you are told you do not may have access to, ask whether your state has a program for people just above the income limit. Some states have "spend-down" programs where you can set aside medical expenses to bring your countable income below the limit. Others have special programs for people with high medical costs.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you may have access to for both, you can and should have both. They work together, not against each other. Having both programs almost always costs you less out of pocket than having Medicare alone.

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

Medicaid is a state program, so your coverage ends when you move. You must apply for Medicaid in your new state. Contact the new state's Medicaid office as soon as you move. Your Medicare coverage continues no matter where you live, but you should update your address with Medicare so they can reach you.

Can I lose Medicaid if my income goes up slightly?

Yes. Medicaid income limits are strict, and if your income rises above the limit, you may lose coverage. However, some states have programs that let you keep Medicaid even if your income is slightly above the limit, especially if you have high medical costs. Ask your state Medicaid office about "medically needy" or "spend-down" programs.

If I have dual may be able to access, do I still need a Medigap or Medicare Advantage plan?

Usually not. Medicaid covers most of the out-of-pocket costs that Medigap or Medicare Advantage plans are designed to cover. However, some people with dual may be able to access choose Medicare Advantage plans specifically designed for dual-may be able to access people because those plans may offer extra benefits like dental or vision care. Ask your state Medicaid office whether this makes sense in your situation.

Who do I call if there is a billing problem with my dual coverage?

Start with the provider's billing office and ask them to check whether they billed both Medicare and Medicaid correctly. If they did not, ask them to resubmit the claim to Medicaid. If the problem continues, contact your state Medicaid office — they can investigate whether Medicaid received the claim and why it was or was not paid.