If you're currently on Medicaid and approaching 65, or qualify for Medicare due to a disability, you might be worried about what happens to your health coverage.

This is a common concern - many people fear they'll have to choose between Medicare and Medicaid, potentially losing important benefits or facing new healthcare costs.

The good news is that in many cases, you can have both Medicare and Medicaid at the same time.

This guide will help you understand how these two programs work together, what determines whether you can keep your Medicaid when getting Medicare, and what steps to take to maintain the coverage you need.

What is Medicare?

Medicare is a federal health insurance program primarily for people 65 and older. Some younger people with disabilities or certain medical conditions also qualify. The government runs Medicare the same way across all 50 states.

Medicare has different parts:

• Part A covers hospital stays (most people get this free)
• Part B covers doctor visits and outpatient care (has a monthly premium)
• Part D covers prescription medications (optional, with varying costs)

In 2025, the standard Part B premium is $179.80 per month, though this amount may be higher for those with higher incomes.

What is Medicaid?

Medicaid is a health insurance program for people with low income or limited resources. Unlike Medicare, both federal and state governments manage Medicaid together.

This means Medicaid rules can be different depending on which state you live in.

Medicaid typically covers:

• Doctor visits
• Hospital stays
• Long-term care services
• Prescription drugs
• Many services Medicare doesn't cover

The Main Differences

The main difference is who these programs are designed to help:

• Medicare is mainly based on age (65+) or certain disabilities
• Medicaid is based on financial need (income and resources)

Can You Have Both Medicare and Medicaid?

Yes! Many people qualify for both Medicare and Medicaid. When you have both, you're called "dual eligible." According to recent data, about 12.5 million Americans are dual eligible.

Having both programs is often better than having just one.

Medicare pays first for covered services, and then Medicaid helps pay for costs that Medicare doesn't cover. This can mean fewer out-of-pocket expenses for you.

Will Medicaid Go Away When I Get Medicare?

The simple answer: it depends on your situation. Getting Medicare does not automatically make you lose Medicaid.

What really matters is whether you still meet your state's Medicaid eligibility requirements, which are mainly based on:

• Your income
• Your assets (like savings and property)
• Your household size
• Other factors specific to your state

If your income and assets stay below your state's limits, you can keep Medicaid when you get Medicare.

Common Scenarios When Getting Medicare

Turning 65 with Medicaid

If you already have Medicaid and are turning 65, you'll automatically be enrolled in Medicare Part A (hospital insurance).

You'll also receive information about enrolling in Medicare Part B (medical insurance).

What happens to your Medicaid depends on your financial situation:

1. If your income and assets are still below your state's limits: You'll keep Medicaid and become dual eligible. Medicaid will help pay your Medicare premiums and other costs.
2. If your income or assets are above your state's limits: You might lose full Medicaid coverage but could still qualify for Medicare Savings Programs (discussed later).

Qualifying for Medicare Due to Disability

If you qualify for Medicare before age 65 due to disability, similar rules apply:

1. You'll receive Medicare after collecting Social Security Disability Insurance (SSDI) for 24 months.
2. If your income and assets remain within your state's Medicaid limits, you can keep your Medicaid coverage.

Changes in Income or Assets

Sometimes, life changes can affect your Medicaid eligibility:

• Getting a new job or increased income
• Receiving an inheritance
• Selling property

These changes might affect your Medicaid eligibility, whether or not you have Medicare. The important thing is to report any changes to your state Medicaid office promptly.

Types of Dual Eligibility Programs

Not all dual eligibility is the same. There are different levels of combined Medicare-Medicaid coverage:

Full Dual Eligibility

If you qualify for full Medicaid benefits while having Medicare, you get the most comprehensive coverage. Full dual eligibility means:

• Medicare covers most of your basic healthcare needs
• Medicaid covers Medicare premiums, deductibles, and coinsurance
• Medicaid covers additional services Medicare doesn't (like long-term care)

To get full dual eligibility, you must meet your state's regular Medicaid income and asset limits, which vary by state. In 2025, many states have expanded their programs to include more people.

Medicare Savings Programs (MSPs)

If your income or assets are too high for full Medicaid but still limited, you might qualify for Medicare Savings Programs. These are special types of Medicaid benefits that help pay Medicare costs.

The main Medicare Savings Programs are:

Qualified Medicare Beneficiary (QMB) Program

• Pays Medicare Part A and Part B premiums
• Covers deductibles, coinsurance, and copayments
• Income limit: generally up to 100% of Federal Poverty Level (about $14,790 each year for individuals in 2025)

Specified Low-Income Medicare Beneficiary (SLMB) Program

• Pays only Medicare Part B premiums
• Income limit: between 100-120% of Federal Poverty Level

Qualifying Individual (QI) Program

• Pays only Medicare Part B premiums
• Income limit: between 120-135% of Federal Poverty Level
• Limited spots available (first-come, first-served)

Qualified Disabled and Working Individuals (QDWI) Program

• Helps certain people with disabilities who return to work
• Pays Medicare Part A premiums only

Special Situations and Considerations

Beyond the standard rules for Medicare and Medicaid, several special situations may affect your coverage.

These situations often require special attention and understanding of how the two programs work together in specific circumstances.

Long-Term Care Needs

Long-term care is one of the most important considerations for many people with both Medicare and Medicaid, as the costs can quickly become overwhelming without proper coverage.

If you need nursing home care or extensive home health services, Medicaid becomes especially important. Medicare provides very limited coverage for long-term care, typically covering only:

• Up to 100 days in a skilled nursing facility after a hospital stay
• Limited home health services for people who are homebound

Medicaid, however, is the primary payer for long-term care in the United States. Medicaid pays for about 62% of all nursing home residents' care.

To qualify for Medicaid long-term care coverage, most states have special financial eligibility rules that may differ from regular Medicaid. Always check with your state's Medicaid office for specific requirements.

Medicare Advantage Plans for Dual Eligibles

For those with both Medicare and Medicaid, specialized Medicare Advantage plans offer a way to better coordinate care between the two programs and often provide additional benefits.

If you have both Medicare and Medicaid, you may have special Medicare Advantage plan options called "Dual Special Needs Plans" (D-SNPs).

These plans:

• Coordinate your Medicare and Medicaid benefits
• Often include extra benefits like dental, vision, and hearing coverage
• Usually have no premiums or other costs if you have full Medicaid

In 2025, about 5.1 million dual-eligible individuals are enrolled in D-SNPs.

Moving to Another State

Geographic mobility presents special challenges for Medicaid recipients, as moving across state lines requires establishing eligibility under a new state's rules.

Medicaid eligibility and benefits vary by state. If you move to a new state:

1. You'll need to apply for Medicaid in your new state
2. You may face different eligibility requirements and benefit structures
3. Your Medicare coverage will remain the same (as it's a federal program)

Always apply for Medicaid in your new state as soon as possible after moving to avoid gaps in coverage.

How to Take Action and Advocate for Yourself

Before Getting Medicare

If you already have Medicaid and will soon get Medicare (turning 65 or qualifying through disability), take these steps:

1. Contact your state Medicaid office about 3-6 months before Medicare begins. Ask how Medicare will affect your specific Medicaid coverage.
2. Check if you need to apply for Medicare Part B or if you'll be automatically enrolled.
3. Understand your prescription drug coverage options between Medicare Part D and Medicaid drug coverage.
4. Consider meeting with a benefits counselor from your State Health Insurance Assistance Program (SHIP) for free, personalized advice. Find your local SHIP at shiphelp.org or by calling 1-877-839-2675.

If You're Worried About Losing Medicaid

If you're concerned about losing Medicaid when getting Medicare:

1. Request a pre-eligibility determination from your state Medicaid office to understand if you'll still qualify.
2. Ask about Medicare Savings Programs if your income or assets are slightly too high for full Medicaid.
3. Apply for Extra Help for Medicare prescription drug costs. In 2025, this program helps people with annual income below $21,870 (individual) or $29,580 (married couple) and limited assets.
4. Appeal any denial decisions if you believe you still qualify. Every state has an appeals process for Medicaid decisions.

Maintaining Dual Coverage

If you have both Medicare and Medicaid:

1. Respond to all renewal notices for Medicaid promptly. Most states require yearly renewal of Medicaid benefits.
2. Report any changes in income, assets, or household size to your Medicaid office.
3. Keep good records of all communications with Medicare and Medicaid offices.
4. Review your coverage annually during Medicare Open Enrollment (October 15-December 7) to make sure you have the best options.

Bottom Line

The most important takeaway is that getting Medicare does not automatically make you lose Medicaid. The programs are designed to work together for people who qualify for both.

Whether you keep Medicaid when getting Medicare depends on:

• Your income
• Your assets
• Your state's specific Medicaid rules
• Any special eligibility categories you might fit into

Having both Medicare and Medicaid often provides the most comprehensive health coverage available, with Medicare acting as your primary insurance and Medicaid filling many of the gaps.

If you're ever uncertain about your coverage, reach out to your state Medicaid office or SHIP counselor. These free resources can provide personalized guidance for your specific situation.

Remember: You have rights as a Medicare and Medicaid beneficiary, including the right to appeal decisions and request clear explanations about your benefits. Don't hesitate to ask questions and advocate for yourself to maintain the coverage you need.