Q: Can I have both Medicare and Medicaid at the same time?
A: In many cases, yes. Some people do qualify for both Medicare and Medicaid, and in those instances, most of the enrollee’s health care costs are covered. People who are eligible for Medicaid and Medicare are known as dual eligible. About 20 percent of Medicare beneficiaries are also eligible for Medicaid. They can be eligible for full Medicaid benefits in addition to Medicare, or for Medicare and an income-based Medicare Savings Program.
When dual eligible beneficiaries have claims, Medicare pays first and Medicaid pays last.
Eligibility for Medicaid and Medicare Savings Programs is determined by each state, while the federal government determines Medicare eligibility. Many low-income seniors living in nursing homes are dual eligible – qualifying for Medicare based on their age, and for Medicaid (which pays for their custodial or long-term care that Medicare does not cover) based on their low income and assets.
- You can also get Medicare and Medicaid if you’re under 65, have certain disabilities and have low income and asset levels.
- Since Medicare does not cover many types of home or nursing care considered to be custodial care, Medicaid often is the go-to source for care at home or in a nursing home.
- Medicaid coverage for care at home (as opposed to in a nursing home or other facility) varies by state, and can include a home attendants and other programs to help you live and function independently.
- Conversely, Medicare can cover skilled services, such as physical therapy, provided in your home. Medicare can also cover some home attendant services while you are also receiving physical therapy or other “skilled care.”
- If you have Medicare and Medicaid, you may be able to enroll in a special health plan that covers the services of both programs, and may offer extra benefits. For example, some plans for people with Medicare and Medicaid offer prepaid debit cards for over-the-counter medicines, extra coverage for hearing aids, and vision or dental care.
- Note: If you have Medicare and Medicaid or an MSP, you can make changes to your Medicare health plan year-round.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He managed a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals.
In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including as an associate at Sachs Policy Group, where he worked with insurer, hospital and technology clients on Medicare and Medicaid issues.
Contributions to healthinsurance.org and medicareresources.org represent only his own views.