Can you have both Medicare and Medicaid?

Can I have Medicare and Medicaid at the same time?

Yes. Medicaid is a joint federal and state program that helps cover medical costs for certain people with limited income, including the elderly and people with disabilities, and the rules about who's eligible are different in each state. Generally, you must meet your state's income and resource rules and other rules, like being a resident of the state. If you meet your state's resource limit but your income is too high, some states let you 'spend down' the income above the Medicaid limit by paying non-covered medical expenses and cost sharing, like Medicare premiums and deductibles, until your income is low enough to qualify.

People who have both Medicare and full-benefit Medicaid are 'dually eligible'. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services. Starting January 1, 2027 (or earlier in some states), certain adults must complete at least 80 hours per month of work or other approved activities to qualify for Medicaid and keep their coverage, but this requirement doesn't apply to people with Medicare. For how the two programs differ, see What is the difference between Medicare and Medicaid?.

Who pays first if I have Medicare and Medicaid?

Medicare does. When you're dual eligible and get Medicare-covered services, Medicare pays first, and Medicaid pays last, after Medicare and any other health insurance you have. Medicaid may also pay for other drugs and services that Medicare doesn't cover.

What does Medicaid pay for if I have Medicare?

If you have Medicare and qualify for full-benefit Medicaid coverage:

• Your state pays your monthly Medicare Part B premiums.
• Depending on the level of Medicaid you qualify for, your state might pay your share of Medicare costs, like deductibles, coinsurance and copayments.
• Your state might also pay your Part A premium, if you have to pay one.
• Medicaid may pay for other drugs and services Medicare doesn't cover.
• Separately, state Medicare Savings Programs help people who qualify pay Part A and Part B premiums. In the Qualified Medicare Beneficiary (QMB) program, Medicare providers aren't allowed to bill you for services and items Medicare covers, including deductibles, coinsurance and copayments, though you may get a bill for a small Medicaid copayment if one applies. See How can I get help paying for Medicare?.

How do prescription drugs work if I have Medicare and Medicaid?

If you're dually eligible, Medicare covers your prescription drugs. You're automatically enrolled in a Medicare drug plan that covers your drug costs instead of Medicaid, though Medicaid may still cover a prescription Medicare doesn't cover in certain situations.

You also get Extra Help automatically, a Medicare program that helps pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance and other costs, and you get a notice in the mail telling you what you'll pay and naming your new drug plan if you didn't have one. You can pick a different Medicare drug plan if you want, and you won't pay a Part D late enrollment penalty while you get Extra Help.

What Medicare plans are there for people with both?

You still choose how you get Medicare: Original Medicare or a Medicare Advantage Plan (Part C). If you choose Medicare Advantage, there are special plans for dual eligibles that make it easier to get the services you need, include Medicare drug coverage (Part D) and may also cost less:

• Dual Eligible Special Needs Plans (D-SNPs): Medicare Advantage plans for people eligible for both Medicare and Medicaid. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits, depending on the state and your eligibility.
• Integrated D-SNPs: combine your Medicare benefits and most or all of your Medicaid benefits in a single plan, with one member ID card, a single health risk assessment, a care coordinator or case manager, and one process for appeals and complaints for both programs.
• Medicare-Medicaid Plans: available only in certain states.
• Program of All-Inclusive Care for the Elderly (PACE): can help certain people get care outside of a nursing home.
• Special Needs Plans may not be available everywhere in the U.S., and you can stay enrolled only while you continue to meet the plan's eligibility rules. See What is a Medicare Special Needs Plan (SNP)?.

When can I change plans if I have Medicare and Medicaid?

More often than most people with Medicare. If you have Medicare and Medicaid, or get Extra Help, you can make changes to your drug coverage once a calendar month, effective the first day of the next month: switch to a different Medicare drug plan, or drop a Medicare Advantage Plan with drug coverage and return to Original Medicare by joining a stand-alone Medicare drug plan. This Special Enrollment Period isn't available if your plan identifies you as an 'at-risk' or 'potential at-risk' beneficiary under a Part D drug management program.

If you have Medicare and full Medicaid benefits, you can also join or switch to an integrated D-SNP, if one is available in your area, once a calendar month. If you lose Medicaid eligibility, you have 3 full months to change your Medicare Advantage or drug plan, counted from the date you're no longer eligible or the date you're notified, whichever is later.