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Can I have both Medicare and Medicaid at the same time?

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.

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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.

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Related terms

custodial care

dual eligible

long-term care

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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.

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?

pedro

great post