Learn what happens when Medicaid beneficiaries become eligible for Medicare. Explore dual eligibility, Medicare enrollment, Medicaid coverage changes, prescription assistance, Medicare Savings Programs, and Dual Eligible Special Needs Plans. This guide explains important steps, eligibility considerations, and resources for understanding healthcare coverage during the transition to Medicare.
If you have Medicaid and are approaching Medicare eligibility, understanding how the two programs work together is an important step in preparing for continued healthcare coverage. Most people become eligible for Medicare at age 65, while others qualify earlier because of certain disabilities. Individuals who qualify for both programs are called dual eligible beneficiaries. Depending on their circumstances, they may receive assistance with Medicare premiums, prescription medications, and other healthcare expenses. This guide explains enrollment requirements, potential changes to Medicaid coverage, Medicare Savings Programs, and available resources to help beneficiaries navigate the transition and understand their coverage options.
If you currently receive Medicaid and are approaching Medicare eligibility, you may be able to keep Medicaid while enrolling in Medicare. People enrolled in both programs are commonly called dual eligible beneficiaries.
Medicare generally becomes the primary payer for Medicare-covered services, while Medicaid pays after Medicare and other applicable insurance. Depending on your eligibility category and state rules, Medicaid may continue to provide additional coverage and assistance with healthcare expenses. <Cite refs={["turn905003search1","turn905003search0"]}/>
Important things to understand include:
Most people first become eligible for Medicare around their 65th birthday. The Initial Enrollment Period generally begins three months before the month you turn 65 and ends three months after your birthday month.
If you already receive Social Security benefits, you may be automatically enrolled in Medicare. Otherwise, you may need to apply through Social Security. Medicare recommends contacting your state Medicaid office to understand whether you will be enrolled automatically and how your existing coverage may change. <Cite refs={["turn905003search5","turn905003search10"]}/>
Before your Medicare eligibility date, consider:
Do not assume that Medicaid enrollment automatically completes your Medicare enrollment.
Dual eligibility means a person qualifies for both Medicare and Medicaid. The type of Medicaid coverage you receive can affect which expenses and services are covered.
People with full-benefit Medicaid may receive additional healthcare services beyond those covered by Medicare. Medicaid may help with certain long-term care services, personal care, and other benefits depending on state eligibility rules. <Cite refs={["turn905003search0","turn905003search1"]}/>
Depending on your circumstances, Medicaid may help with:
The specific benefits depend on whether you qualify for full Medicaid or a more limited form of assistance.
If you have limited income and resources, you may qualify for programs that help pay Medicare-related expenses.
Medicare Savings Programs are administered by states and can help eligible beneficiaries with Medicare premiums and, in some cases, other out-of-pocket expenses. Extra Help is a federal program that assists eligible beneficiaries with Medicare Part D prescription drug costs. <Cite refs={["turn905003search0","turn905003search1"]}/>
Programs to investigate include:
Some people automatically qualify for Extra Help because they receive Medicaid or certain Medicare Savings Program benefits. Others may need to apply separately.
Contact your state Medicaid office to find out which programs are available and whether your current eligibility will continue after Medicare enrollment.
After becoming eligible for Medicare, you generally have options for receiving your Medicare coverage. These include Original Medicare and Medicare Advantage, subject to applicable enrollment requirements.
People with Medicare and Medicaid may also be eligible for Dual Eligible Special Needs Plans, commonly called D-SNPs. These are Medicare Advantage plans designed for people who qualify for both programs. Some plans coordinate Medicare and Medicaid services, although availability and eligibility vary by location. <Cite refs={["turn905003search2","turn905003search1"]}/>
When comparing coverage options, review:
Medicare beneficiaries who have Medicaid or Extra Help may qualify for certain Special Enrollment Periods that allow changes to prescription drug coverage or eligible integrated plans during the year. <Cite refs={["turn905003search6"]}/>
Understanding Medicare and Medicaid rules can be complicated, particularly when eligibility, benefits, and enrollment procedures differ between states.
You can contact your state Medicaid office, Social Security, or Medicare for information about enrollment and coverage. Free Medicare counseling is also available through the State Health Insurance Assistance Program, known as SHIP. <Cite refs={["turn905003search4","turn905003search5"]}/>
Helpful steps include:
If you have Medicaid and are aging into Medicare, you may be eligible to receive benefits from both programs. Medicare generally becomes the primary payer for covered services, while Medicaid may help with premiums, cost-sharing, and additional healthcare needs. Enrollment requirements, eligibility categories, and coverage details depend on your circumstances and state rules. Reviewing your options early and contacting Medicare, Social Security, or your state Medicaid office can help you prepare for the transition and understand available assistance.