Can You Have Medicare and Medicaid at the Same Time?

Whoever coined the phrase “less is more” clearly wasn’t considering healthcare coverage. 

Navigating your coverage options in retirement can be complicated, especially if you’re also trying to determine your eligibility for Medicare and Medicaid. Fortunately, it’s possible to qualify for both programs simultaneously, and many seniors have found that leveraging their dual eligibility allows them to maximize the quality of their care. And with the right guidance, seniors can unlock the full potential of both programs.

Medicare vs. Medicaid

Before diving into who is eligible for both Medicare and Medicaid, we should first break down the differences between the programs. 

Medicare is a federal health insurance program primarily designed for individuals who are 65+ or have certain disabilities. It covers hospital stays, doctor visits, and preventive care. Medicare has four parts:

• Part A: Hospital insurance, which covers inpatient stays, hospice care, and some types of nursing care
• Part B: Medical insurance, which covers outpatient care
• Part C: Medicare Advantage plans, an alternative to Parts A and B that bundles several coverage types
• Part D: Prescription drug coverage

On the other hand, Medicaid is a joint federal and state program that provides health coverage for individuals with limited assets or resources, including seniors. Medicaid eligibility and benefits vary by state, but it can cover services that Medicare does not.

One of the most significant benefits of Medicaid is its coverage of long-term care, which Medicare generally does not cover. Here are some key aspects of Medicaid’s long-term care benefits:

• Nursing Home Care: Medicaid can cover the cost of care in a skilled nursing facility.
• Home and Community-Based Services (HCBS): These programs, available in some states, allow individuals to receive care in their homes or community settings rather than in institutional facilities.
• Personal Care Services: Medicaid may pay for assistance with activities of daily living, such as bathing, dressing, and eating.
• Case Management: Medicaid can provide support to coordinate care services for individuals with complex needs.

Read more: What Are the Medicaid Lookback and Penalty Periods?

Who is Eligible for Both Medicare and Medicaid?

If you are 65+ and are either a U.S. citizen or a legal permanent resident who has lived in the U.S. for five consecutive years, then you qualify for Medicare. That’s not the only way to qualify, though. Even if you don’t match the above criteria, you may still be eligible if you have end-stage renal disease, amyotrophic lateral sclerosis (ALS), or another type of qualifying disability or chronic condition.

Eligibility for Medicaid benefits is determined based on income, assets, and medical necessity. Proper planning can help individuals qualify for these critical services while protecting their financial resources.

You may qualify for both programs if:

1. You meet the criteria for Medicare (age, disability, or medical condition).
2. Your income and resources meet your state’s Medicaid limits.

How Does Dual Eligibility Work?

If you qualify for both Medicare and Medicaid, you’re considered “dual-eligible” and can access benefits from each program. In this case, Medicare serves as your primary insurance, covering hospital and medical costs. In contrast, Medicaid may cover copayments, deductibles, and services not included in Medicare—such as long-term care. In other words, dual eligibility can be beneficial, because it allows you to access more comprehensive coverage, particularly regarding long-term care. 

By understanding the unique benefits of each program and how they complement one another, you can make informed decisions for yourself or your loved ones. For professionals, leveraging Medicare and Medicaid planning strategies can ensure your clients achieve peace of mind and financial security.

Read more: How Much Does Medicaid Pay for Long-Term Care?

Take the Next Step

Now you know that the answer to the question “Can you have Medicare and Medicaid at the same time?” is a resounding yes! But maybe you still have other questions about applying for coverage and determining how to protect your assets.  

Fortunately, we’re here to help. Tell us about your situation and discover the right solution for you.