How Do Medicare and Medicaid Work Together?
Key Takeaways
- When you qualify for Medicare and MedicaidMedicaid is a state-based health insurance program for individuals that qualify. Unlike Medicare, Medicaid does not have age restrictions for members. , you are dual eligible. Dual eligibility allows beneficiaries to combine Medicare and Medicaid benefits to expand coverage and assist with costs. It is not a separate plan.
- Most seniors qualify for Medicare at age 65. Some seniors on a fixed income also qualify for Medicaid due to low income or limited resources. An individual under 65 receiving Social Security Disability Insurance can have Medicaid and later enroll in Medicare after 24 months of receiving Social Security Disability benefits, or upon reaching the age of 65.
- Medicaid benefits cover additional costs outside of Medicare coverage, and some benefits not covered by Medicare.
The Medicaid program helps more than 70 million people in the U.S. with limited incomes and resources access medical services. If you qualify for both Medicare and Medicaid, you may be able to get additional assistance with your healthcare costs.
Find the Medicare Plan that works for you.
What’s the Difference Between Medicaid and Medicare?
Medicaid is an assistance program that provides health coverage with low out-of-pocket costs (or no cost) for covered services. For anyone who qualifies, Medicaid enrollment is open the entire year. When it’s time to enroll in Medicaid, it is essential to know your state-level program follows federal guidelines for standard coverage but may have expanded coverage.
Medicare is a public health insurance program. Most people who use Medicare are 65 years of age or older. Patients pay part of their medical costs through deductibles, premiums, copayments, and coinsurance. Medicare is a federal program and is administered the same nearly everywhere in the United States. Medicare enrollment is available at specific times during the year, including initial enrollment, Medicare’s Open Enrollment Period, the Medicare Advantage Open Enrollment and Special Enrollment Periods (SEP).
Can You Have Medicare and Medicaid?
Medicaid assists seniors with limited income and people with disabilities who are also enrolled in Medicare.
If you qualify for coverage from both Medicaid and Medicare, you’re a “dually eligible beneficiary.” You may first enroll in Medicare and then qualify for Medicaid, or enroll first in Medicaid but later qualify for Medicare.
How does dual eligibility work?
Dual-eligible beneficiaries can have:
- Medicare Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare.
- Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare.
- Both Part A and Part B
- Full Medicaid benefits
- State Medicare Savings Programs
- Dual Eligible Special Needs Plans (D-SNPs)
Medicare benefits always pay first, and Medicaid benefits assist with costs not fully covered by Medicare.
Medicaid will pay premiums and out-of-pocket expenses for dual-eligible Medicare beneficiaries. Medicare and Medicaid work together to cover costs, including long-term services. Medicaid covers any qualified medical costs not covered by Medicare up to your state’s payment limit.
Your state’s Medicaid program may also cover services that Medicare doesn’t, like prescription drugs, eyeglasses, and hearing aids.
Dual Eligible Special Needs Plans
A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage (Part C) plan offered by private insurance carriers. D-SNPs are designed to provide comprehensive health coverage and may offer additional benefits.
D-SNPs are required to at least match the coverage you would get under Original Medicare and to include Part D prescription drug coverage.
Partial Dual Eligibility
If you don’t quite qualify for full Medicaid benefits under your state’s rules, you may have partial dual eligibility. Partial dual eligibility can enable you to enroll in one of these Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
Find more information by visiting your state’s Medicaid website or talk with a licensed insurance agent about the options available in your area.
My Medicare coverage doesn’t address all of my needs.
What Is Covered?
Federally administered Medicare coverage is standardized for all beneficiaries throughout the United States. Original Medicare coverage includes Part A (hospital) and Part B (medical).
On the other hand, your state government sets the rules, regulations, and policies for Medicaid within federal guidelines.
Your Medicare Part A and Part B benefits do not change with dual eligibility, but the level of Medicaid coverage may vary. Whether you qualify for “partial” or “full” dual eligibility depends on your income and assets:
- Partial coverage may include Medicaid coverage for expenses like Medicare premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. , deductiblesA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. , and coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. Your insurance company pays the remaining amount. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you’ll pay $200. Your insurance company will cover the final $800. .
- Full coverage provides the same benefits as partial coverage and may also include services not covered by Medicare like long-term care.
What Are My Costs With Dual Eligibility?
Dual eligibility can limit individual costs for beneficiaries. For those with Medicare, state Medicaid programs will pay for many cost-sharing and out-of-pocket expenses for medical services.
For any service you receive, Medicare pays first and covers all eligible costs. Any qualified costs not covered by Medicare will be covered by Medicaid.
Can I change plans if I’m dual eligible?
As of 2025, people who are dual eligible and qualify for full Medicaid benefits from their state can use a monthly Special Enrollment Period to join certain D-SNPs. Reach out to an insurance carrier or a licensed insurance agent for more information about the D-SNPs available in your area.
Where do I apply for Medicaid?
What is the history of Medicaid, and how is it tied to Medicare?
While Medicare is a federal program focused on assisting Americans beginning at age 65, Medicaid is a federal/state partnership focused on those in need, regardless of age. Most states have adopted a federally backed expansion of Medicaid covered that debuted in 2014.
Can I bundle multiple benefits into one plan?
Sources
- Medicare Savings Programs. Medicare.gov.
- Seniors & Medicare and Medicaid Enrollees. Medicaid.gov.
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