Medicare Medicaid Eligible Plans

How Does Medicaid Work?

If you are eligible for Medicare and have a sufficiently low income, you may qualify for help from certain Medicaid programs in your state. Whether you qualify will depend on:

  • Your earned and unearned income, including wages and Social Security payments
  • Your assets, including checking accounts, stocks, and some property
  • Your nursing care and long-term care needs, you must meet your state’s functional eligibility criteria (standards for assessing your need for help with activities of daily living, such as, toileting, bathing, and dressing). Each state sets its own standards.

Medicaid programs vary by state, but below are three Medicaid programs available to Medicare beneficiaries in all states. Note that in all of these cases, if you have both Medicare and Medicaid, Medicare will pay first for covered services, and Medicaid will pay second for qualifying costs. If you meet income, asset, and other guidelines in your state, you may qualify for one of the following Medicaid programs:

Dual eligibility

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 (Part C). If you have Medicare and full Medicaid, you'll get your Part D prescription drugs through Medicare. And, you'll automatically qualify for Extra Help paying for your Medicare prescription drug coverage (Part D). Medicaid may still cover some drugs and other care that Medicare doesn’t cover.

Who pays first — Medicaid or Medicare?

Medicaid never pays first for services covered by Medicare. It only pays after Medicare, employer group health plans, and/or Medicare Supplement (Medigap) Insurance have paid.

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