En español | No, you won’t lose Medicaid coverage just because you qualify for Medicare.
As long as you continue to meet the eligibility requirements for Medicaid in your state, you’ll receive both types of coverage even after you enroll in Medicare. Both Medicare and Medicaid cover more than 11.2 million people, which is known as being “dual eligible.”
Medicare is a federal program that covers medical expenses for more than 64.5 million Americans 65 and older — and younger people who qualify because of a disability. Medicaid, which federal and state governments run jointly, provides health care and long-term care coverage for more than 83.5 million people, including children, parents, low-income adults, older adults and people with disabilities.
While the federal government sets standards for Medicaid, individual states determine your eligibility, generally based on your income and financial assets. Coverage details vary by state so consider contacting your state Medicaid office or your State Health Insurance Assistance Program (SHIP) to learn more about the requirements and what’s covered.
If you’re eligible for both Medicare and Medicaid, Medicare settles your medical bills first by paying its share of the cost of covered expenses. Medicaid becomes secondary and pays costs after Medicare’s covered share, which includes most of Medicare’s deductibles, copayments and other out-of-pocket costs.
Medicaid can pay for Medicare premiums and some items that Medicare doesn’t cover, such as long-term care in a nursing home. In some states, Medicaid also covers dental care, glasses, long-term care in your home, transportation to and from doctor’s visits, and other items Medicare doesn’t.
Those eligible for both Medicare and Medicaid can get their Medicare coverage from original Medicare or a private Medicare Advantage plan. Some Advantage plans are created specifically for dual eligibles and help coordinate the two types of coverage. Some of these plans provide members with a care coordinator who helps them navigate their benefits.
If you have Medicaid and then become eligible for Medicare, you’ll have to find new prescription coverage through Medicare’s Part D drug program. Then you’ll automatically qualify for the federal Extra Help program, which enables you to receive Part D drug coverage without paying premiums or deductibles. You’ll also have low copays for your drugs.
But to get this coverage, you need to enroll in a Part D drug plan. If you don’t do this yourself, the Centers for Medicare & Medicaid Services (CMS) will select one for you.
Part D costs, coverage and preferred pharmacies vary by plan, so it’s a good idea to shop around and choose a plan that works best for you and your circumstances. You can compare coverage for your medications and pharmacies under the plans in your area with the Medicare Plan Finder or you can work with your SHIP to get help choosing the best Part D plan for your needs.
You may no longer qualify. If you had Medicaid coverage before you turned 65, you may no longer be eligible after you turn 65. Some Medicaid programs don’t continue coverage past 65, but the rules vary a lot by program and state. Find out about the requirements from your state Medicaid office.
You can still get help. Even if you don’t qualify for Medicaid, a Medicare Savings Program can still assist you with Medicare expenses. These programs help participants pay Medicare Part A and Part B premiums, deductibles and copayments, depending on the program you qualify for. Eligibility is based on income and assets, which vary by state.
And possibly extra help. You may also qualify for help with Part D premiums and copayments from the Extra Help program, which has higher income limits than Medicaid and is expanding to even higher income levels in 2024.
Updated November 17, 2022
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