Can You Have Medicare and Medicaid at the Same Time?

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Seniors Blue Book

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Aug 05, 2026

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National

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Yes, you can have Medicare and Medicaid at the same time.

People who qualify for both programs are commonly called dual eligible beneficiaries. Medicare and Medicaid can work together to reduce healthcare expenses and provide services that one program alone may not cover.

The details can be confusing because Medicare is a federal program, while each state operates its own Medicaid program within federal guidelines. Eligibility limits, covered services, application procedures, and estate recovery rules may differ depending on where you live.

Here is what seniors and their families need to know.

What Is Dual Eligibility?

Dual eligibility means a person qualifies for Medicare and also receives some level of Medicaid assistance.

Medicare generally covers adults age 65 and older, as well as certain younger people with disabilities or qualifying health conditions. Medicaid assists eligible people with limited income and resources. State Medicaid programs determine eligibility under federal and state rules.

There are two general types of dual eligibility.

Full Benefit Dual Eligibility

A person with full Medicaid benefits may receive help with Medicare costs and access to additional Medicaid services.

Medicaid benefits vary by state. States determine the amount, duration, and scope of many services within federal guidelines.

Partial Benefit Dual Eligibility

Some people do not qualify for full Medicaid benefits but qualify for a Medicare Savings Program.

The amount of help depends on the specific Medicare Savings Program. Income and resource limits can differ by state, and some states use limits that are higher than the federal amounts.

Which Program Pays First?

For services covered by Medicare, Medicare generally pays first.

Medicaid usually pays after Medicare and any other available health insurance. Medicaid may cover some or all of the remaining approved costs, depending on the person’s eligibility, the service, and the state’s payment rules.

Medicaid does not pay first for a service Medicare covers.

A Simple Example

Suppose a dual eligible beneficiary visits a doctor for a Medicare covered service.

  1. The provider bills Medicare.
  2. Medicare processes the claim and pays its approved share.
  3. Medicaid may consider the remaining deductible, coinsurance, or copayment.
  4. The amount Medicaid pays depends on the person’s coverage and state rules.

People enrolled in the Qualified Medicare Beneficiary program cannot be billed by Medicare providers for Medicare covered deductibles, coinsurance, or copayments. A small Medicaid copayment may still apply in certain circumstances.

How Medicaid May Help With Medicare Costs

Medicaid can make Medicare more affordable for eligible seniors.

Medicare Part B Premiums

For people with full benefit Medicaid, the state generally pays the monthly Medicare Part B premium.

Some Medicare Savings Programs also pay the Part B premium for eligible beneficiaries. Certain programs may provide additional help with Part A premiums and Medicare cost sharing.

Deductibles, Coinsurance, and Copayments

Depending on the level of Medicaid or Medicare Savings Program eligibility, Medicaid may help pay Medicare deductibles, coinsurance, and copayments.

Not every dual eligible beneficiary receives the same assistance. Some receive full Medicaid benefits, while others receive only help with specific Medicare costs.

Prescription Drug Costs

Medicare, rather than Medicaid, generally provides prescription drug coverage for dual eligible beneficiaries through Medicare Part D.

People with full benefit Medicaid or a Medicare Savings Program automatically qualify for the Medicare Extra Help program. Extra Help can reduce Part D premiums, deductibles, coinsurance, copayments, and other prescription expenses.

Medicaid may cover a limited number of medications that are excluded from Medicare Part D coverage, depending on state rules.

Can Medicaid Help Pay for Personal Care at Home?

Medicare usually focuses on medical and skilled services. It generally does not cover ongoing assistance needed only for daily activities over an extended period.

Medicaid may cover personal care and home and community based services for eligible people. These programs are intended to help older adults and people with disabilities receive support in their homes or communities instead of moving into an institution.

Coverage is not automatic. Applicants may need to meet financial requirements and show that they need a certain level of assistance.

Home and community based programs can also have different eligibility rules, service limits, provider networks, or waiting lists. Contact the state Medicaid agency for information about programs available locally.

Can Medicaid Pay for Nursing Home Care?

Medicare may cover limited skilled nursing facility care when specific requirements are met. It does not generally pay for an indefinite nursing home stay based only on a person’s need for custodial care.

Medicaid can pay for long term nursing facility services for financially and medically eligible individuals. The nursing home must participate in Medicaid, and the applicant must meet the state’s nursing facility level of care requirements.

Medicaid nursing facility coverage may include:

  • Nursing and related care
  • Rehabilitation services
  • Room and board
  • Dietary services
  • Medically related social services
  • Pharmaceutical services
  • Activities
  • Routine personal hygiene items and services

Residents may still be responsible for contributing part of their income toward the cost of care. Rules regarding income, assets, spouses, and allowable personal expenses vary by state.

Can You Choose Original Medicare or Medicare Advantage?

Dual eligible beneficiaries may generally receive Medicare through Original Medicare or a Medicare Advantage plan.

Some Medicare Advantage Special Needs Plans are designed specifically for people who have both Medicare and Medicaid. These are called Dual Eligible Special Needs Plans, or D-SNPs.

Plan availability, networks, costs, and benefits vary. Seniors should confirm that their doctors, hospitals, pharmacies, and medications are covered before enrolling.

PACE may also be available in some areas for eligible adults age 55 and older who require a nursing home level of care but can safely live in the community. Most PACE participants are dual eligible, and the program coordinates Medicare and Medicaid services.

Medicaid Rules Differ by State

Medicare rules are primarily federal, but Medicaid programs are administered by individual states.

State differences may include:

  • Income limits
  • Asset limits
  • Medical eligibility requirements
  • Covered personal care services
  • Home and community based programs
  • Application documents
  • Renewal procedures
  • Provider availability
  • Estate recovery practices
  • Protections beyond federal minimum requirements

Do not assume that another person’s Medicaid experience will apply in your state.

Contact your state Medicaid agency to confirm current rules. Seniors and caregivers can also seek free Medicare counseling through their local State Health Insurance Assistance Program.

What Is Medicaid Estate Recovery?

Medicaid estate recovery is the process through which a state may seek repayment from the estate of a deceased Medicaid beneficiary for certain benefits Medicaid paid.

For beneficiaries age 55 and older, states are federally required to seek recovery for payments involving:

  • Nursing facility services
  • Home and community based services
  • Related hospital services
  • Related prescription drug services

States may choose to recover the cost of other Medicaid services. However, states may not recover Medicare cost sharing paid for Medicare Savings Program beneficiaries.

Estate recovery generally occurs after the Medicaid beneficiary dies. It is separate from determining whether someone currently qualifies for Medicaid.

When Estate Recovery Is Restricted

Federal protections prevent a state from recovering from the estate while the deceased beneficiary is survived by:

  • A spouse
  • A child younger than 21
  • A blind child of any age
  • A child with a disability of any age

States must also have procedures for waiving recovery when it would create an undue hardship.

Because estate recovery rules and definitions of an estate can differ by state, families should seek state specific information before transferring property, changing ownership, creating a trust, or applying for long term care Medicaid.


Frequently Asked Questions

Can seniors have Medicare and Medicaid together?

Yes. Seniors who meet the requirements for both programs can be enrolled in Medicare and Medicaid at the same time.

Does Medicaid replace Medicare?

No. Medicare remains the primary payer for Medicare covered services. Medicaid generally pays after Medicare and may cover additional approved services.

Will Medicaid pay the Medicare Part B premium?

It may. Full benefit Medicaid and Medicare Savings Programs can pay the Part B premium for eligible beneficiaries.

Does Medicaid cover prescription medications?

Medicare Part D generally provides prescription coverage for dual eligible beneficiaries. Medicaid may cover certain medications excluded from Part D, depending on the state.

Does Medicaid cover home care?

Medicaid may cover personal care and home and community based services, but eligibility, services, and availability differ by state.

Can Medicaid take a home after someone dies?

A state may seek estate recovery for certain Medicaid benefits after a beneficiary dies. Federal protections apply when there is a surviving spouse, a child under 21, or a blind or disabled child of any age. State rules should be reviewed with a qualified professional.


Having Medicare and Medicaid together can reduce healthcare costs and provide access to services that Medicare alone may not cover. The challenge is understanding which benefits are available in your state and where to find qualified local assistance.

For help finding resources in your area, contact Seniors Blue Book:

Email: [email protected]
Phone: 800-201-9989

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