What Medicaid Covers for Older Adults

Medicaid coverage for older adults depends on your state, your income, and whether you also have Medicare

Medicaid does not have a separate program for older adults — you stay on the same Medicaid you had at 55 or 60. What changes is what you need it to cover. Most people over 65 have Medicare, which covers hospital and doctor visits. Medicaid then pays for the things Medicare does not: long-term care, dental, vision, hearing aids, and prescription drugs if your income is low enough. Some states cover more than others, and some older adults may have access to for both programs at once.

The first step is knowing whether you have Medicaid now. If you do not, the income limit to get it as an older adult is usually higher than it was when you were younger — most states allow more income if you are over 65. If you have Medicare but no Medicaid, you may still may have access to for a program that helps pay your Medicare premiums and out-of-pocket costs.

Key Takeaways

• Medicaid covers long-term care, dental, vision, and hearing aids for older adults in most states, but what is covered varies by state.
• If you have both Medicare and Medicaid, Medicaid usually pays your Medicare premiums and covers costs Medicare does not, like nursing home care.
• Income limits for Medicaid are higher for people over 65 in most states, and some states count only your own income, not your spouse's.
• You can have Medicaid and Medicare at the same time, and the two programs coordinate so you do not pay twice for the same service.
• Your state Medicaid office determines what is covered, so calling your state directly is faster than searching online.

What Medicaid covers that Medicare does not

Medicare covers doctor visits, hospital stays, and some rehabilitation after a hospital stay. Medicaid fills in the gaps. If you have both programs, Medicaid pays for nursing home care, assisted living in some states, home health aides, dental work, vision care, hearing aids, and prescription drugs. It also covers transportation to medical appointments in most states.

The catch is that coverage varies by state. New York covers dental and vision for all Medicaid members over 21. Texas covers dental only for people under 21 and pregnant women. Some states cover hearing aids; others do not. Your state Medicaid program publishes a list of what it covers, but the easiest way to know what applies to you is to call your state Medicaid office and ask directly.

If you have Medicaid but no Medicare, Medicaid covers everything — doctor visits, hospital stays, prescriptions, and long-term care. You do not have to choose between them.

How income limits work for people over 65

Each state sets its own income limit for Medicaid. For people over 65, the limit is usually higher than for working-age adults. In 2024, some states allow income up to $1,500 or $2,000 a month for a single person, though this varies. A few states use a higher limit for older adults; others use the same limit for everyone.

Income is counted differently depending on your situation. If you are married and only one spouse is over 65 and applying for Medicaid, some states count only that person's income. Other states count both spouses' income together. If your spouse is in a nursing home and you are at home, many states allow you to keep more of the household income and assets — this is called "spousal impoverishment protection," and it exists so the well spouse does not become poor while the other gets care.

Your state Medicaid office can tell you the exact income limit and how your situation is counted. Income limits change, so do not assume last year's number is still correct.

Long-term care coverage and how it works

Medicaid is the main payer for nursing home care in the United States. If you need a nursing home and your income and assets are low enough, Medicaid covers the full cost. Medicare covers only the first 100 days after a hospital stay, and only if you are improving. After that, you pay out of pocket unless you have Medicaid.

To get Medicaid to pay for a nursing home, you must meet your state's income and asset limits. Asset limits vary widely — some states allow $2,000 in assets for a single person, others allow more. Your home and one car do not count toward the limit in most states. Money in a revocable living trust usually counts; money in an irrevocable trust may not, depending on the terms and your state's rules.

If you have too many assets to may have access to for Medicaid now, you can spend down — pay for care yourself until your assets fall below the limit. Medicaid has rules about how quickly you can give away money or transfer assets; if you do it too fast, you may face a waiting period before Medicaid will pay. A Medicaid planner or elder law attorney can explain the rules for your state.

How Medicaid and Medicare work together

If you have both programs, they coordinate. When you see a doctor, Medicare pays first (up to what it covers). Medicaid then pays your Medicare copay and coinsurance, and covers services Medicare does not cover at all. You should not have to pay anything out of pocket for covered services.

You need to give both your Medicare card and your Medicaid card to your doctor's office. The office will bill Medicare first, then send the bill to Medicaid for the remaining balance. If the office does not do this automatically, call and ask them to coordinate benefits.

Some older adults may have access to for a program called Medicare Savings Programs, which helps pay your Medicare premiums and out-of-pocket costs even if you do not have full Medicaid. These programs have lower income limits than full Medicaid but can save you hundreds of dollars a year. Your state Medicaid office can tell you whether you may have access to.

Prescription drug coverage under Medicaid

If you have Medicaid, your state Medicaid program covers prescription drugs. The list of covered drugs (called a formulary) varies by state. Some states cover almost all drugs; others have a shorter list and may require your doctor to get approval before you fill a prescription.

If you have Medicare Part D (prescription drug coverage) and Medicaid, Medicaid is the backup payer. Medicare Part D pays first, and Medicaid covers the costs Medicare does not. You do not pay a copay to Medicaid for drugs that Medicare covers.

If a drug you need is not on your state's Medicaid formulary, your doctor can ask for an exception. The state has to respond within a certain number of days. If the exception is denied, you have the right to appeal.

Dental, vision, and hearing coverage

Medicaid coverage of dental, vision, and hearing aids is the most variable benefit across states. Some states cover all three for all ages; some cover them only for children; some do not cover them at all. A few states cover emergency dental only.

If your state does cover these services, there are usually limits. Dental might cover cleanings and fillings but not cosmetic work. Vision might cover one eye exam and one pair of glasses per year. Hearing aids might be covered once every three years. Call your state Medicaid office to ask what your state covers and whether there are waiting lists.

If your state does not cover a service you need, ask whether there are other programs. Some nonprofits offer free or low-cost dental and vision care for older adults. Your Area Agency on Aging can point you to local programs.

How to find out what your state covers

The fastest way is to call your state Medicaid office directly. You can find the number on your Medicaid card or by searching "[your state] Medicaid" online. Have your Medicaid number ready. Tell them you want to know what is covered for older adults — dental, vision, hearing aids, long-term care, and anything else you are wondering about.

You can also visit your state Medicaid website, which usually has a member handbook that lists covered services. The handbook is often long and written in technical language, but it is the official source. If you cannot find what you need online, call.

If you do not have Medicaid yet and want to know whether you may have access to, your state Medicaid office can tell you the income and asset limits. You can also contact your local Area Agency on Aging, which can help you understand your options and connect you to local resources.

Frequently Asked Questions

Can I have Medicaid and Medicare at the same time?

Yes. Most people over 65 have Medicare, and if your income is low enough, you can also have Medicaid. When you have both, they work together — Medicare pays first for covered services, and Medicaid covers what Medicare does not. You are called a "dual may be able to access."

Does Medicaid cover nursing home care if I have Medicare?

Medicare covers only the first 100 days in a nursing home after a hospital stay, and only if you are improving. After that, you pay out of pocket unless you have Medicaid. If you have Medicaid, it covers the full cost of nursing home care once you meet the income and asset limits.

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

Your Medicaid ends in your old state and you must apply in your new state. Each state has different income limits and coverage, so you may not may have access to in the new state, or your coverage may change. Apply as soon as you move so there is no gap in coverage.

Do I have to spend all my money before Medicaid will pay for a nursing home?

No. Your state has an asset limit, and you must be below it to may have access to. You can spend down by paying for care yourself, but there are rules about how fast you can give away money. An elder law attorney can explain the rules for your state and help you plan.

Can my spouse's income disqualify me from Medicaid?

It depends on your state and your situation. If you are married and both applying for Medicaid, most states count both incomes together. If only one spouse is applying, some states count only that person's income. If one spouse is in a nursing home, spousal impoverishment rules may protect part of the household income. Call your state Medicaid office to ask how your situation is counted.