Can You Receive Medicare and Medicaid at the Same Time?

Yes, You Can Receive Both Medicare and Medicaid

It is possible to be enrolled in both Medicare and Medicaid at the same time. When a person qualifies for both programs, they are often called "dual eligible." Medicare generally pays first, and Medicaid helps cover costs that Medicare does not, including premiums, deductibles, and services that Medicare may not pay for at all. The exact benefits depend on the individual's income, assets, and state of residence.

How Dual Eligibility Works

Medicare is a federal program primarily for people aged 65 and older, or those with certain disabilities or end-stage renal disease. Medicaid is a joint federal and state program for people with limited income and resources. Because the programs have different eligibility rules, some people meet the requirements for both. In these cases, Medicaid acts as a payer of last resort, filling in the gaps left by Medicare.

What Medicare Covers

• Hospital care under Part A
• Medical services and outpatient care under Part B
• Prescription drugs under Part D

What Medicaid May Cover

• Medicare premiums, deductibles, and coinsurance
• Nursing home care and long-term services not fully covered by Medicare
• Vision, hearing, and dental services not typically covered by Medicare

Who Qualifies for Dual Eligibility

Qualification depends on two separate standards. For Medicare, a person must either be 65 or older, or meet disability or medical condition requirements. For Medicaid, a person must fall within their state's income and asset limits. Some people automatically qualify for a Medicare Savings Program through Medicaid, which helps pay Medicare costs. Others may receive full Medicaid benefits that go well beyond what Medicare provides.

Special Needs Plans and Coordination

Dual eligible individuals may be enrolled in Medicare Advantage Special Needs Plans (SNPs) designed for people with both Medicare and Medicaid. These plans often include extra benefits and coordinate with Medicaid to simplify coverage. The state Medicaid agency and Medicare work together to manage benefits, but the specifics vary by state.

Why Dual Eligibility Matters

Being dual eligible can significantly reduce out-of-pocket health care costs. Medicaid may cover services Medicare does not, and it can help pay for long-term care, which Medicare generally does not cover for extended periods. People who think they may qualify should contact their state Medicaid office and the Social Security Administration to check their eligibility.