You don’t actually switch from Medicare to Medicaid. The two programs work together, and most people who qualify for Medicaid while on Medicare end up keeping both. This setup is called “dual eligibility,” and it can dramatically reduce your out-of-pocket costs. If your income has dropped or your medical expenses have climbed, adding Medicaid to your existing Medicare coverage is the real goal, and the process starts with your state Medicaid office.
Why You Keep Medicare When You Get Medicaid
Medicare and Medicaid serve different roles. Medicare is a federal program tied to age (65+) or disability, while Medicaid is a joint federal-state program for people with limited income and assets. When you qualify for both, Medicare acts as the primary payer. It covers hospital stays, doctor visits, and prescription drugs first. Medicaid then picks up remaining costs that Medicare doesn’t fully cover.
This matters because Medicaid fills expensive gaps. Depending on your level of Medicaid eligibility, your state may pay your Medicare Part B premium (currently $185 per month for most people), your deductibles, copayments, and coinsurance. Medicaid also covers services Medicare generally doesn’t, like long-term nursing home care and personal care services. Dropping Medicare to go Medicaid-only would actually leave you with less coverage, not more.
Who Qualifies for Dual Eligibility
Eligibility depends on your income, your assets, and which state you live in. At the federal level, there are several tiers of help, each with its own income ceiling. These figures include a standard $20 monthly income disregard:
- Qualified Medicare Beneficiary (QMB): Income up to $1,350/month for an individual ($1,824 for a couple). Covers Part A and Part B premiums, plus deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB): Income up to $1,616/month for an individual ($2,184 for a couple). Covers Part B premiums only.
- Qualifying Individual (QI): Income up to $1,816/month for an individual ($2,455 for a couple). Also covers Part B premiums only.
- Qualified Disabled and Working Individual (QDWI): Income up to $5,405/month for an individual ($7,299 for a couple). Covers Part A premiums only.
For the first three programs, the asset limit is $9,950 for an individual and $14,910 for a couple. The QDWI program has lower asset limits of $4,000 and $6,000. These are the federal baseline numbers. Some states use more generous income and asset rules, so you may qualify in your state even if you’re above these thresholds. Alaska and Hawaii also have higher limits due to cost of living.
Full Medicaid coverage (beyond just help with Medicare costs) has its own eligibility criteria that vary significantly by state, particularly in states that expanded Medicaid under the Affordable Care Act. Your state Medicaid agency can tell you exactly which programs you qualify for based on your specific situation.
How to Apply
Because Medicaid is run at the state level, you apply through your state’s Medicaid agency, not through Medicare. Every state has its own application process, but the general steps are the same. You’ll need to provide proof of income (Social Security statements, pension records, any other income), proof of assets (bank statements, property records), your Medicare card or Medicare number, and proof of identity and residency.
You can typically apply online through your state’s Medicaid website, in person at a local Medicaid office, by phone, or by mail. Many states also allow you to apply through the federal Health Insurance Marketplace at healthcare.gov, which will route your application to the appropriate state agency. If you’re already receiving Supplemental Security Income (SSI), some states automatically enroll you in Medicaid without a separate application.
What Happens to Your Medicare After Approval
Once approved for Medicaid, your Medicare coverage stays in place. Medicare continues to be the primary payer for services it covers. When you see a doctor or go to the hospital, the claim goes to Medicare first. Whatever Medicare doesn’t pay, Medicaid picks up as the secondary payer. This “coordination of benefits” happens automatically between the two programs.
For prescription drugs, Medicare remains in charge. You’ll be automatically enrolled in a Medicare Part D drug plan, and you’ll also automatically receive “Extra Help,” which is a federal subsidy that sharply reduces your drug costs. If Medicare doesn’t cover a specific medication you need, Medicaid may still cover it separately.
Changing Your Medicare Plan After Getting Medicaid
One major advantage of becoming dually eligible is flexibility with your Medicare plan. Most Medicare beneficiaries can only change plans during the annual Open Enrollment Period each fall. But if you have both Medicare and Medicaid, you get a Special Enrollment Period that lets you make changes once per calendar month, year-round. Each change takes effect on the first day of the following month.
With this monthly flexibility, you can switch to a different Medicare drug plan, drop a Medicare Advantage plan and return to Original Medicare with a standalone drug plan, or join a Dual Eligible Special Needs Plan (D-SNP). D-SNPs are specifically designed for people with both Medicare and Medicaid. They coordinate benefits from both programs into a single plan, which can simplify everything from finding providers to understanding your costs. Some D-SNPs offer zero-dollar cost sharing for Medicare-covered services. You can check whether a D-SNP is available in your area through Medicare’s plan finder at medicare.gov.
If Your Income Is Too High
If your income is above your state’s Medicaid limits, you may still have a path. Many states offer a “medically needy” or spend-down program. This works similarly to a deductible: you subtract your medical expenses from your income, and once your remaining income drops below the state’s threshold, you become eligible for Medicaid. The medical bills you’ve incurred but haven’t had covered by insurance count toward this spend-down amount. Once you hit the target, Medicaid covers additional costs going forward.
Not every state offers a medically needy program, so this option depends on where you live. Your state Medicaid office can tell you whether spend-down is available and what the income threshold is.
Extra Help With Drug Costs
Even if you don’t qualify for full Medicaid, you may qualify for Extra Help (also called the Low Income Subsidy) to reduce your Medicare prescription drug costs. The income limit for Extra Help is $23,940 per year for an individual or $32,460 for a couple. Resource limits are $18,090 for an individual and $36,100 for a couple. You can apply for Extra Help through Social Security at ssa.gov, by calling Social Security at 1-800-772-1213, or at your local Social Security office. If you qualify for any level of Medicaid, you get Extra Help automatically.