Yes, Medicare and Medicaid can work together, and millions of seniors use both at the same time

If you have both Medicare and Medicaid, they coordinate to pay your medical bills. Medicare is your primary payer — it pays first on most claims. Medicaid then pays some or all of what Medicare doesn't cover, depending on your state's rules and your income. This combination is sometimes called "dual coverage" or being "dually may be able to access." The two programs have different rules, different income limits, and different coverage areas, so understanding how they split the bill matters for your out-of-pocket costs.

You don't explore to both programs at once or choose between them. If you meet the income and asset limits for Medicaid in your state while also being 65 or older (or disabled and on Medicare), you can have both. Some people find they may have access to for Medicaid only after they turn 65 and start Medicare, because Medicare counts as income in some states' Medicaid calculations.

Key Takeaways

  • Medicare pays first on your medical bills, and Medicaid covers some costs Medicare leaves behind, but the exact split depends on your state.
  • You must meet both programs' income and asset rules separately — having Medicare does not automatically may have access to you for Medicaid.
  • Some states offer special Medicare Savings Programs that pay your Medicare premiums and cost-sharing without requiring you to meet full Medicaid income limits.
  • Your out-of-pocket costs are usually lowest when both programs cover you, because Medicaid fills gaps that Medicare does not.
  • You report changes in income, living situation, or household size to both programs, because they track may be able to access separately.

How the two programs split the bill

When you have both programs, Medicare processes your claim first. It pays its share based on what it covers and what you've already paid toward your deductible. Then the claim goes to Medicaid, which looks at what Medicare paid and what you still owe. Medicaid may pay part or all of the remaining bill, depending on what your state's Medicaid program covers and your income level within Medicaid.

The catch is that Medicaid rules vary by state. In some states, Medicaid will pay your Medicare Part B premium (the monthly charge for doctor visits). In others, it will pay your deductible and copays. A few states cover all three. Your state Medicaid office can tell you exactly what it will and won't pay toward your Medicare costs. This is not something Medicare itself decides — it's a state-by-state choice.

If you use a service that Medicare doesn't cover at all, Medicaid may still cover it if your state's Medicaid program includes it. For example, some states' Medicaid covers dental work or hearing aids, which Medicare does not. In that case, you would bill Medicaid directly, not Medicare.

Income and asset limits for having both programs

You must meet the income and asset rules for both programs separately. Medicare has no income limit — anyone 65 or older can have it. But Medicaid does have income limits, and they differ by state. In 2024, most states set the Medicaid income limit somewhere between 74% and 100% of the federal poverty level for a single person, though some states are higher. You can contact your state Medicaid office or use the Medicaid.gov website to find your state's current limit.

Medicaid also counts your assets — savings, investments, property you own. Most states allow you to keep a small amount (often around $2,000 for a single person) before Medicaid says you have too much. Medicare does not count assets at all. So you could have $50,000 in the bank and still get Medicare, but that same $50,000 might disqualify you from Medicaid in your state.

Some people become Medicaid-may be able to access only after they turn 65 because their income changes or because they move to a state with higher limits. Others lose Medicaid may be able to access if their income rises above the state limit, even though they keep Medicare. This is why it's important to report income changes to your state Medicaid office.

Medicare Savings Programs: a middle ground if you don't quite may have access to for Medicaid

If your income is slightly above your state's Medicaid limit, you may still be able to get help paying Medicare costs through a Medicare Savings Program. These are state-run programs that pay some or all of your Medicare premiums and cost-sharing without requiring you to meet full Medicaid income limits. The income thresholds are higher — usually between 120% and 200% of the federal poverty level, depending on which program and which state.

There are three Medicare Savings Programs: the may have access to Medicare Beneficiary (QMB) program, which pays your Part B premium, deductible, and copays; the Specified Low-Income Medicare Beneficiary (SLMB) program, which pays your Part B premium only; and the may have access to Individual (QI) program, which also pays your Part B premium. Your state decides which ones it offers and what the exact income limits are. You contact your state Medicaid office to ask about these programs and whether you meet the income threshold.

These programs are useful because they let you keep more of your income than full Medicaid would allow, but you still get help with Medicare costs. You don't have to spend down your assets to may have access to, the way you might for full Medicaid in some states.

What happens to your coverage if your income changes

If your income rises above your state's Medicaid limit, you lose Medicaid coverage but keep Medicare. You would then be responsible for Medicare's full deductibles and copays unless you have other insurance (like coverage from a former employer) or you may have access to for a Medicare Savings Program at the higher income threshold.

If your income drops — for example, if you stop working or a spouse passes away — you may become newly Medicaid-may be able to access. You should report the change to your state Medicaid office right away, because Medicaid coverage can sometimes start the month you report the change, not the month you actually became may be able to access. Missing the reporting window could mean paying out-of-pocket for bills that Medicaid would have covered.

Changes in your living situation also matter. If you move to a different state, you must explore for Medicaid in your new state, because each state runs its own program with its own rules. Your Medicare coverage moves with you automatically, but Medicaid does not.

Costs you still pay even with both programs

Having both Medicare and Medicaid does not mean you pay nothing. You still pay the Medicare Part B premium each month (unless Medicaid or a Medicare Savings Program covers it). You may still have copays for doctor visits or prescriptions, depending on what your state's Medicaid covers. If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your out-of-pocket costs work differently, and you should check with your plan about how Medicaid coordinates with it.

Prescription drug coverage (Part D) also matters. If you have both programs, Medicaid usually pays for drugs that Medicare Part D doesn't cover, and it may help with Part D copays. But the exact coverage depends on your state and your specific drug. Always check with your pharmacy or your state Medicaid office before assuming a drug is covered.

How to learn about you may have access to for Medicaid while on Medicare

Contact your state Medicaid office directly. You can find the phone number on Medicaid.gov by selecting your state, or you can call 211 and ask for the Medicaid office in your area. Have your Social Security number, birth date, and recent income information (like a pay stub or bank statements) ready. The office will tell you whether your income and assets meet the state's limits and what documents you need to send.

If you think you might may have access to for a Medicare Savings Program instead, ask the Medicaid office about that too. They can tell you the income thresholds for QMB, SLMB, and QI programs in your state and whether you meet them. Some states combine the process for Medicaid and Medicare Savings Programs, so you may be considered for both at once.

Questions to ask your doctor or Medicaid office

Before a medical visit or procedure, ask your doctor's office whether they accept both Medicare and Medicaid. Some providers accept Medicare but not Medicaid, or vice versa. Ask what your out-of-pocket cost will be after both programs pay. If you're prescribed a new medication, ask the pharmacy whether it's covered by your Medicaid plan and what your copay will be.

Ask your state Medicaid office in writing what services it covers that Medicare does not — dental, hearing aids, vision care, transportation to medical appointments. These vary widely by state, and knowing what's available can help you plan your care. Also ask what happens to your coverage if your income changes, so you know when to report changes and what to expect.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you meet your state's Medicaid income and asset limits while also being 65 or older (or disabled and on Medicare), you can have both programs. Medicare is your primary payer, and Medicaid covers some costs Medicare leaves behind. The exact split depends on your state's Medicaid rules.

What if I have Medicare Advantage instead of Original Medicare?

Medicaid can still work with Medicare Advantage, but the coordination is different. Your Medicare Advantage plan is primary, and Medicaid covers some of what the plan doesn't. Tell your plan that you have Medicaid, and ask them how they coordinate benefits. Some plans have special rules for people with dual coverage.

Will I lose Medicare if I lose Medicaid?

No. Medicare and Medicaid are separate programs. If your income rises above your state's Medicaid limit, you lose Medicaid but keep Medicare. You would then pay Medicare's full deductibles and copays unless you have other insurance or may have access to for a Medicare Savings Program.

Do I have to report changes in income to both programs?

Yes. Medicare doesn't have income limits, so income changes don't affect Medicare. But Medicaid does track income, so you must report changes to your state Medicaid office. If your income rises above the limit, you lose Medicaid. If it drops, you may become newly may be able to access.

What if my state doesn't cover something Medicare doesn't cover?

Then you pay out-of-pocket, or you look for other coverage. Some seniors buy supplemental insurance (Medigap) to cover costs that neither Medicare nor Medicaid covers. Ask your state Medicaid office what services are covered and what your options are if a service you need isn't included.