Do I need Medicare if I have Medicaid?

Asked by: Miss Mazie Hammes  |  Last update: January 9, 2026
Score: 4.5/5 (35 votes)

In most cases, even if you have Medicaid, you must enroll in Medicare when you're eligible. This is because Medicare is the primary insurance and will provide benefits and coverage for the health care services you need. If you do not enroll when you're eligible, you may face a late enrollment penalty.

Why would you have both Medicare and Medicaid?

When an individual has both Medicare Parts A and B, Medicare is the primary insurance and pays for most medical care. Medi-Cal is the secondary insurance, and it pays for costs not covered by Medicare and provides additional benefits not covered by Medicare.

Is it better to be on Medicare or Medicaid?

Medicaid technically offers the best coverage as most everything is covered at 100% where as Medicare only covers a portion of most services and the patient is responsible for the rest, either out of pocket or by purchasing supplemental private insurance that covers all or part of the difference.

Do I have to have Medicare if I don't want it?

Strictly speaking, Medicare is not mandatory. But very few people will have no Medicare coverage at all – ever. You may have good reasons to want to delay signing up, though.

What is the downside of Medicaid?

Disadvantages of Medicaid

One of the primary reasons for this is that Medicaid reimbursements are lower than those of commercial insurers for most procedures and treatments.

Do I need Medicare if I have Medicaid? Dual eligibility with Medicare and Medicaid

35 related questions found

Why do most doctors not accept Medicaid?

One reason is that reimbursement rates for Medicaid are lower than for Medicare or commercial insurance. Another (often overlooked) factor, however, is physician's risk of payment denials and the administrative hassle they face trying to get reimbursed by Medicaid.

What does Medicaid not cover?

Though Medicaid covers a wide range of services, there are limitations on certain types of care, such as infertility treatments, elective abortions, and some types of alternative medicine. For example, the federal government lists family planning as a mandatory service benefit, but states interpret this differently.

Will I lose my Medicaid if I get Medicare?

People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

Does everyone have to pay $170 a month for Medicare?

Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.

How to decline Medicare at age 65?

2 ways to drop coverage
  1. Contact Social Security.
  2. If you recently got a welcome packet saying you automatically got Medicare Part A and Part B, follow the instructions in your welcome packet, and send your Medicare card back.

Do I need Medicare Advantage if I have Medicaid?

Dual eligibility

Some people qualify for both Medicare and Medicaid and are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.

What happens if you make too much money while on Medicaid?

If you're over the Medicaid income limit, some states let you spend down extra income or place it in a trust to help you qualify for Medicaid. If you receive long-term care but your spouse doesn't, Medicaid will allow your spouse to keep enough income to avoid living in poverty.

Is it better to have Medicare or Medicaid?

Medicaid offers benefits that Medicare doesn't normally cover, like nursing home care and personal care services. People with Medicaid usually don't pay anything for covered medical expenses but may owe a small co-payment for some items or services. Find out if you qualify for your state's Medicaid program.

How much does Medicaid cost per month?

Amounts. Most states adjust premium amounts by beneficiary income, with approved possible charges ranging from approximately $5 to $74 per month. Four states (AR, AZ, MI, and MT) have approved waivers to require monthly premium payments as a percentage of income.

How much does Medicare cost at age 65?

If you don't get premium-free Part A, you pay up to $518 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($185 in 2025).

How to get Medicare for free?

You're eligible for Part A at no cost at age 65 if 1 of the following applies: You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB). Your spouse (living or deceased, including a divorced spouse) receives or is eligible to receive Social Security or RRB benefits.

How much money can you have in the bank if you're on Medicare?

eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.

How do you know if you're dual eligible for Medicare and Medicaid?

According to the Centers for Medicare & Medicaid Services, you may qualify for dual eligible benefits if5: You are enrolled in Original Medicare (Part A, Part B, or both); and. Receive full Medicaid benefits; or. Get help with your Medicare out-of-pocket costs through a Medicare Savings Program (MSP)

What happens to Medicaid when you turn 65?

While the ACA expanded Medicaid's income eligibility for non-elderly adults, the federal minimum standard for Medicaid eligibility for those 65 and older remained unchanged at approximately 75 % of the FPL.

Is everything free with Medicaid?

States can impose copayments, coinsurance, deductibles, and other similar charges on most Medicaid-covered benefits, both inpatient and outpatient services, and the amounts that can be charged vary with income. All out of pocket charges are based on the individual state's payment for that service.

What is excluded from Medicaid?

Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, ...

Does Medicaid cover surgery?

When it comes to surgical procedures, both Medicare and Medicaid provide coverage for many medically necessary surgical services received under inpatient and outpatient treatment.