Can I be enrolled in Medicare and Medicaid at the same time?

Q: Can I be enrolled in Medicare and Medicaid at the same time?

A: In many cases, yes. Some Americans qualify for both Medicare and Medicaid, and when this happens, it usually means they don’t have any out-of-pocket healthcare costs.

Beneficiaries with Medicare and Medicaid are known as dual eligibles – and account for about 20 percent of Medicare beneficiaries (12.1 million people). Dual eligibles are categorized based on whether they receive partial or full Medicaid benefits. Full benefit dual eligibles have comprehensive Medicaid coverage, while partial benefit dual eligibles receive help with Medicare’s premiums and cost sharing through a Medicare Savings Program (MSP). (Some beneficiaries have Medicare, Medicaid and an MSP.)

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The federal government oversees Medicare eligibility – meaning it is the same in each state. But states set their own eligibility rules for Medicaid and the MSPs (within federal guidelines) – and income limits for these programs vary widely.

How are my health care costs reimbursed if I have Medicare and Medicaid?

When dual eligible beneficiaries have healthcare expenses, Medicare pays first and Medicaid pays last. But this is not the case for things Medicare doesn’t cover, like long-term care. If Medicaid is covering a beneficiary’s long-term care, Medicare will still be the primary payer for any Medicare-covered services – like skilled nursing care or physical therapy.

Although it is less common, if a dual eligible individual has additional coverage (such as a Medigap plan) then Medicare pays first, Medigap will pay second, and Medicaid is the last payer for their claims (for expenses covered by all three).

How do I know if I should be dual eligible?

Beneficiaries can find out if they’re eligible for Medicaid by contacting their Medicaid office. An Internet search for Medicaid offices in a beneficiary’s state should provide the number to call – but beneficiaries should make sure they are contacting a government office before sharing any personal information.

The Centers for Medicare and Medicaid Services (CMS) also maintains a list of state agencies that oversee Medicaid. Beneficiaries can see if they already have Medicaid by contacting 1-800-MEDICARE and asking whether they receive “Extra Help” with their prescription drug costs (beneficiaries with Medicaid are automatically enrolled in this program).

What is the income range for beneficiaries who are dual eligibles?

Generally, beneficiaries earning less than 135 percent of the federal poverty level are eligible for the MSP if they also have limited savings (although some states don’t require beneficiaries to have low assets). This equates to $17,226 annually for single beneficiaries and $23,274 for married couples. Beneficiaries qualify for full Medicaid benefits if their incomes and assets are even lower (but the exact amounts vary by state).

Many seniors who live in nursing homes are dual eligible – qualifying for Medicare based on their age, and Medicaid because of their financial circumstances. It is also common for Medicare beneficiaries who are under 65 and live on Social Security Disability Insurance (SSDI) to have Medicaid or an MSP.

Many low-income beneficiaries are enrolled in Medicaid but don’t know it – so it never hurts to ask about these benefits.

Can I select an insurance plan for my Medicare and Medicaid benefits?

If you are dual eligible, you are can enroll in a duals special needs plan (D-SNP) that includes Medicare and Medicaid benefits. These plans may pay for expenses the two types of coverage don’t cover individually – including some over-the-counter items – and could have extra coverage for things like hearing aids, vision and dental care.  Beneficiaries who are dual eligible can change between Original Medicare and Medicare Advantage or switch Part D plans at anytime.


Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated 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.

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Mary Ann Shawmeker

My 40 yr daughter has MS and receives Medicaid and Medicare. She also is a uterine cancer survivor. She works a few hours a week delivering after school meals. Because of expenses associated with MS she needs to be sure that she remains eligible but not sure what she can make and still qualify for both programs. Can you shed any additional guidance on this topic?Thank you.

Josh Schultz

You can find more information on Social Security “Substantial Gainful Activity” earnings levels at the following page: https://www.ssa.gov/oact/cola/sga.html

Josh Schultz

In addition, you can find more information about Medicare eligibility here: https://www.medicareresources.org/medicare-eligibility-and-enrollment/am-i-eligible/. Typically for somebody like your daughter, the rules will vary by the state she lives in. So it may be best to find your local Medicaid office, or an Aging and Disability Resource Center or similar organization, and seek additional input from them on the eligibility rules.

Lisa Whitehall

I need help with my FEDERAL DEEMED DUAL benefits/my state refuses that I have federal match numbers and have been denied Medicaid, and status.., since my deemed award, I am also partially blind.
CMS has repeatedly sent the purple letter.. Stating all about it.

Josh Schultz

It sounds like you have a lot going on. You may want to start by clarifying which state-run benefits you have by contacting your Medicaid office. Also, you may be referring to the Part D Extra Help program. You can inform Medicare (1-800-Medicare) that you’re having issues accessing those benefits.

Janet K Davis

I have medicare now. I am 68 years old. Can I also have medicaid along with medicare?

Yes, Janet. Here’s an article that explains how you can have both.

Elizabeth Menefee

I am 68 and need a supplement. I am low income ,do I qualify for Medicaid also.

Elizabeth, this article explains how you might be eligible for both Medicare and Medicaid:
https://www.medicareresources.org/faqs/can-i-be-enrolled-in-medicare-and-medicaid-at-the-same-time/

Eileen

My brother has stage 4 rectal cancer he’s on disability. After being on Medicaid for 2 years was moved to Medicare which means he lost his pharmacy benefits and has to get a supplement which he can’t afford he doesn’t have money to get by every month now. Can he get both Medicare and Medicaid?

Josh Schultz

He should now have pharmacy benefits through Medicare Part D. If he has questions about his coverage he may want to call 1-800-Medicare.

Josh Schultz

Medicaid eligibility limits change once a person qualifies for Medicare. He may still qualify under the new limits if his only income is Social Security Disability. He should contact his Medicaid office to inquire. Even if he doesn’t qualify for full Medicaid, he might be eligible for a Medicare Savings Program (help with premiums) and/or Extra Help (drug costs): https://www.medicareresources.org/faqs/is-there-help-for-me-if-i-cant-afford-medicares-premiums/ https://www.medicareresources.org/faqs/how-do-i-qualify-for-medicares-extra-help-program/

Fern

Thanks for the info on medicare and medicaid, i learn more on this single page, than having called Horizon 20 times thanks so much

Lori kay Nail

my spouse is 61 and 2 years ago became disabled , he was receiving caresource and medicare then medicare started deducting payment for parts of medicare and he received medicaid , now welfare of ohio has stopped his payment for medicare and also stopped medicaid he receives 1245 monthly he need his medicaid for dr. appts

Susan Bibula

Hello! I am trying to find out which states require (by law) that you have a dual advantage plan. I am on SSDI, and also have Medicaid. I was told yesterday by someone at HRA that it is the law to have an HMO or PPO attached to my Medicare. I asked her if she was referring to Part C, and she said no. It sounds like it is to me, but no one has ever advised me of this. My Medicare only began 12/1/19, so I’m still finding new info all the time. Help would be appreciated. Thank you!

Hi Susan,
It’s possible that you’re in an area where a Medicare-Medicaid Plan has a contract to handle all dual-eligible enrollees. There aren’t very many of these plans (much fewer than Medicare Advantage plans) and they’re in specific counties in 11 states: https://innovation.cms.gov/initiatives/Financial-Alignment/

Susan Bibula

Thank you, Louise. I am in NY (for now) and I was taken aback because in all the conversations I’d had with all these agencies, no one mentioned that until this week! There has been an astounding lack of information given. I have spent too many hours on the phone since October trying to sort this all out. Just when it was all coming together, this news was thrown at me quite suddenly. It has also made things complicated because I had surgery in January, so I can’t even switch yet until some claim issues are resolved. It shouldn’t be… Read more »

Sharon Andrade

My mom, 95, in a nursing home. Has MassHealth and Medicare. Is that enough or does she need a supplement like BCBS?

Elizabeth Ramesdorfer

My husband and I are on Medicare and live on Soc Sec .
I had a bad accident 2017, I’m in physical therapy yet and I had an attack in October and a few there problems! Can we apply for extra help like Medicaid. Would appreciate your guidance. My husband got Disability before MEDICARE and still has same diagnosis.

Camille

I am 55 years old I am currently on medi cal how can I get Medicare too

My ex wife has bad vertigo, ear ringing, sciatic and nerve problems due to bulging discs, she was turned down for SS and to file again is a long road. She has no income and does not work as she never knows when a vertigo attack comes. I help out as much as I can and it is financially draining as I was paying $1000. for insurance for her but had to drop it. She is 54 years old. Are there State of Florida programs that may help?

Ted, I would suggest that you contact a SHIP counselor in Florida for advice about Florida programs that may be of assistance. https://www.seniorsresourceguide.com/directories/National/SHIP/

Kimberly

I receive Medicaid I don’t trust it just goes to show that you shouldn’t trust anybody it just goes to show that you cannot trust anybody Medicare, however these people make it difficult for me to understand. I used to pay $1.25 for my prescriptions and now I just received a past due notice of a past due for over $100. And Humana which I refer to as them, say I have to pay premiums. I’ve been on Humana prescription for over a decade and they just now telling me that I owe this money. I believe that I’m being… Read more »

I’d suggest you contact your state’s insurance commissioner if you have a complaint about your insurer.

Paul Mielke

I receiving medicare for a disability,have been on disability for a little over ten years now,I need surgery from time to time and the twenty percent that I have to pay is a real strain,how do I go about finding out if I can get medicaid to help me out,I’m looking at another surgery in the near future and I don’t think I can afford the twenty percent that I’m required to pay,any help would be appreciated.

Thank you
Paul

Josh Schultz

You may want to consider a Medicare Advantage plan, which can limit your out-of-pocket costs, or a Medigap supplemental plan if one is available to you in your state. With limited SSDI income, you may qualify for Medicaid or the Medicare Savings Program. Contact your local Medicaid office to apply. https://www.medicaid.gov/about-us/contact-us/contact-state-page.html

jerry vehovec

I had Medicaid, but when I turned 65, I was told my Social Security income was now over the limit ($799/mth). I make $1151 SS/mth (I retired at 62 1/2) and that was OK, until I got Medicare. Why is that?
and I would still qualify for the following:
2020 Ohio Medicaid Long Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying)
Income Limit Income Limit
Institutional / Nursing Home Medicaid $2,349 / month $4,698 / month

Josh Schultz

Medicaid eligibility rules change once you qualify for Medicare. States have different rules for people under 65 (not on Medicare) and those 65+. Some people in your situation who age into Medicare may be able to qualify for a Medicaid “spend-down”, where you pay a certain amount of your own costs each month before Medicaid will pay for care.

Luis Robles

My mother and s 86 years old, she had heart surgery a 1 1/2 years ago. She has problems with right leg from polio. Mom was never given proper care for polio.
Mom has lived with me for the past 6 years , dad passed away. She helps us with rent, pays for her personal and health care needs. She covers her life insurance. She pays for all her handicap equipment
She is on Medicare, can she qualify for Medicaid?
She is on ssi. Thanks

Josh Schultz

If she has SSI then she may already have Medicaid. If not, she most likely qualifies. Contact your local Medicaid office to see.

Jeanne Croce

Hello I am currently on medicaid and receive SSD I will turn 65 this June and would like to know if I can keep my medicaid. I have no assets.

Josh Schultz

Once you qualify for Medicare at age 65, you’ll have to meet different rules to continue receiving Medicaid. The income limit if generally lower (if you live in a Medicaid expansion state), and you also probably have to have limit assets. If you don’t qualify for full Medicaid benefits, you may still qualify for a Medicare Savings Program. More information is here: https://www.medicareresources.org/faqs/is-there-help-for-me-if-i-cant-afford-medicares-premiums/

Vickie Coots

I need to know if I have Medicare and Medicaid can I get my incontinence supply’s? Right now Medicaid pays for them

Joan

A 54 y/o female with Bipolar Disorder receives Medicare. Is she eligible for Medicaid as well?

Bernadette Robinson

I have Medicare but it doesn’t cover everything can I get Medicaid added?

Josh Schultz

If you have limited income and resources, you may qualify for Medicaid in addition to your Medicare. You can apply by contacting your Medicaid office: https://www.medicaid.gov/about-us/contact-us/contact-your-state-questions/index.html

Here is more information about the Medicare Savings Program, which is program where the state pays some of your Medicare premiums and other costs: https://www.medicareresources.org/faqs/is-there-help-for-me-if-i-cant-afford-medicares-premiums/

Mitchell Hanson

My Mom is in a nursing home an just got approved for Medicaid does she still keep Medicare?

Josh Schultz

Yes, your mom will keep her Medicare coverage. In some cases, Medicaid will even pay her Medicare premium for her.

Jeanne Sinclair

Hi – I am 61 and on Medicare because of disability. How can I get State or Federal Medicaid in addition to my Medicare – I live in Harford County Mary land

Velma Roybal

My son will soon be eligible for Medicare but now he has Medicaid can he have both he get SSI and SSDI through me and SSI through his disability

Trini O. Baron

Hello, My name is Trinidad Baron. I reside in San Diego , Ca. 92117. I am very confused about my Medicare and Medical. I thought my broker sign me up for both so I do not have to pay for the premium. I just recieved a letter from Social Security that they are deducting $144.00 per month for my Part B. I will be 65 in June, I need to know how to qualify for Medicaid. I thought Medical is Medicaid. Please help me on what to do. I took early retirement but I am only getting $764.00 per month.… Read more »

Carmen

Because of covid-19 income has drop, can I qualify for medical with my Medicare help

Carmen, you will need to contact Medical to inquire about eligibility, but you can also visit this California Medicaid page and you might also want to read this post about staying covered during the pandemic.

Genie Davis

Hi. I now have medicare which doesn’t cover dental. Would I be able to receive Medicaid

Genie, this article explains how you might be eligible for both Medicare and Medicaid:
https://www.medicareresources.org/faqs/can-i-be-enrolled-in-medicare-and-medicaid-at-the-same-time/

PBS

Ok…I have a question for ya. I turn 65 in July and will be required to pay for some medical. However, I had planned and am trying to get two specific things taken care of BEFORE turning 65. Thanks to covid19, they will not take care of my preexisting condition as it is not deemed an emergency. How is that fair? Seems to me that since I can’t get the dental and medical work done that I had planned, why would I not be grandfathered in after turning 65?

Josh Schultz

It sounds like you have an issue that needs to be addressed with your health insurer or the insurance regulator in your state.

But because you’re now Medicare-eligible, I recommend signing up for Medicare. Here is more information on how to do that:
https://www.medicareresources.org/medicare-eligibility-and-enrollment/

Suzette Kandil

My husband is 66 he is ss and he receives Medicare. But he doesn’t have dental or good vision plan. I am currently out of work because of the civic 19. But I am self employed and I think my income will be less than 1,000 per month when I return to work. Can my husband apply for Medicaid.

Laticia McHenry

Can a someone dual-eligible choose a PPO and medicaid? How does that work? What are the out of pocket costs?

Donald S Monts De Oca

I received a medicare supplement which started on June 1st. 2020 . I been having trouble with the one I signed up for would I be able to change to another plan again.

Tommie Griffin

I am married and not presently working. I am 69 yrs old and have Medicare. My wife is 60 yrs old has no incomeand has no insurance. Is she eligible for Medicare?

Tommie,

This article explains eligibility for Medicare: https://www.medicareresources.org/medicare-eligibility-and-enrollment/am-i-eligible/

CA Frazier

I currently have medicaid. I’m 64 yo. When I turn 65, I’d like to keep my medicaid & add medicare. How can I find out if I’d qualify for both @ the same time??

This is from the paragraph above: Beneficiaries can find out if they’re eligible for Medicaid by contacting their Medicaid office. An Internet search for Medicaid offices in a beneficiary’s state should provide the number to call – but beneficiaries should make sure they are contacting a government office before sharing any personal information. The Centers for Medicare and Medicaid Services (CMS) also maintains a list of state agencies that oversee Medicaid. Beneficiaries can see if they already have Medicaid by contacting 1-800-MEDICARE and asking whether they receive “Extra Help” with their prescription drug costs (beneficiaries with Medicaid are automatically enrolled… Read more »