Updated September 16, 2026: Becoming eligible for Medicare does not automatically mean you lose Medicaid. If you qualify for both programs, you are commonly called dually eligible. The key change is usually which program pays first: Medicare generally becomes the primary payer for Medicare-covered services, and Medicaid may continue to help with premiums, cost sharing, and services Medicare does not cover. Exact Medicaid benefits and enrollment steps vary by state. (medicare.gov)
Direct answer: If you are already on Medicaid and are now eligible for Medicare Parts A and B, confirm whether you are enrolled in Medicare and the date coverage starts. Keep responding to Medicaid renewal notices, and contact your state Medicaid agency to learn whether your Medicaid category, provider network, or benefits will change. In many cases, Medicaid pays the Part B premium; it may also help with Part A premiums and Medicare deductibles, coinsurance, and copayments, depending on your Medicaid or Medicare Savings Program eligibility. (medicare.gov)
Already on Medicaid and eligible for Medicare Parts A and B: What changes?
Medicare and Medicaid are separate public health coverage programs. Medicare is generally available at age 65 and to some younger people with qualifying disabilities, ALS, or end-stage renal disease. Medicaid is administered by states under federal rules and is based on financial and other eligibility requirements. Having both is possible. (ssa.gov)
Once you have both programs, Medicare generally pays first for services that Medicare covers. Medicaid is generally the payer of last resort and may cover remaining eligible costs or services outside Medicare’s benefit package, subject to your state’s rules. Examples of services Medicaid may cover beyond Medicare include certain long-term nursing-facility care and personal-care services. (medicare.gov)
Medicare Part A and Part B in simple terms
- Part A (Hospital Insurance): Helps cover inpatient hospital care and certain skilled nursing facility, hospice, and home health services.
- Part B (Medical Insurance): Helps cover doctor and outpatient services, lab work, durable medical equipment, and other medically necessary services. (medicaid.gov)
Medicaid does not simply “turn into” Medicare. Instead, your coverage may become a coordinated combination of both programs.
Will you be enrolled in Medicare automatically?
It depends. People who are receiving Social Security or Railroad Retirement Board benefits at least four months before Medicare eligibility are generally automatically enrolled in premium-free Part A and Part B if they live in the United States, with a special rule for Puerto Rico. People who are not receiving those benefits usually need to take action to enroll. (cms.gov)
Medicare.gov specifically advises people with Medicaid to check with their state Medicaid program when they first become eligible for Parts A and B. Your state may enroll you, or you may need to enroll through Social Security. Do not rely on a verbal assumption—look for your Medicare card or written enrollment notice and verify the effective dates. (medicare.gov)
A practical checklist for the transition
- Confirm your Medicare enrollment. Check whether you have Part A, Part B, or both, and write down each effective date. Social Security handles enrollment in Parts A and B. (ssa.gov)
- Do not cancel Medicaid just because Medicare begins. Medicaid may continue to provide important financial help and services. Keep completing required renewals and reporting changes requested by your state.
- Call your state Medicaid agency. Ask whether you will have full Medicaid, a Medicare Savings Program, or both; whether your Part B premium will be paid; and whether you need to choose a Medicaid managed-care plan.
- Review Medicare prescription-drug coverage. If you have full Medicaid and Medicare, you automatically qualify for Extra Help with Medicare drug costs. Medicare, rather than Medicaid, generally covers outpatient prescription drugs for people who are dually eligible. (medicare.gov)
- Tell your doctors, pharmacy, and other providers. Give them your Medicare card and your Medicaid card so claims can be sent in the correct order.
- Save letters and bills. A premium notice or bill may reflect a timing issue while agencies update their records. Ask before paying a bill you believe Medicaid should cover.
Can Medicaid pay your Medicare premiums and out-of-pocket costs?
Often, yes—but the amount of help depends on your eligibility category and state rules. Medicare.gov says that, for people with full-benefit Medicaid, the state pays the monthly Part B premium. Depending on eligibility, the state may also pay a Part A premium when one is owed and may help with Medicare deductibles, coinsurance, and copayments. (medicare.gov)
Some people receive this help through a Medicare Savings Program (MSP). The principal MSP categories are Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individual (QDWI). States can use rules that are more generous than federal minimum standards, so do not decide you are ineligible based only on a national income figure. (cms.gov)
Important protection if you have QMB
If you are in the QMB program, federal law protects you from being billed for Medicare Part A and Part B deductibles, coinsurance, and copayments for Medicare-covered items and services. This is true even when a provider does not participate in Medicaid, as long as the service is Medicare-covered. If you receive a bill, do not ignore it; contact the provider’s billing office, show your Medicare and Medicaid/QMB information, and contact your state Medicaid office or Medicare for help if the issue is not corrected. (cms.gov)
Example: How the two programs may work together
Maria has full Medicaid and turns 65. She enrolls in Medicare Parts A and B. When she sees a doctor for a Medicare-covered outpatient visit, Medicare is generally billed first. Her Medicaid coverage may then help with eligible remaining costs, and her state may pay her Part B premium. If she later needs a Medicaid-covered personal-care service that Medicare does not cover, Medicaid rules—not Medicare rules—will govern that benefit.
This is an example, not a guarantee of coverage. Provider participation, the service received, your Medicaid category, and your state’s rules all matter.
Should you choose Original Medicare or Medicare Advantage?
Having Medicaid does not remove your Medicare coverage choices. You can generally receive Medicare through Original Medicare or through a Medicare Advantage plan. Some areas offer Dual Eligible Special Needs Plans (D-SNPs) or Medicare-Medicaid Plans designed for people with both programs. These options can coordinate benefits, but availability and networks differ by county and state. (medicare.gov)
Before joining a plan, compare whether your doctors, hospital, pharmacy, prescriptions, Medicaid benefits, and care coordinators will work with it. Do not enroll solely because a plan calls itself a “dual” plan; ask how it coordinates with your specific Medicaid coverage.
What to watch for next
Watch for Medicare enrollment notices, a Medicare card, Medicaid renewal paperwork, and any notice about a drug plan or managed-care plan. If a premium is deducted from a Social Security payment before state assistance is reflected, contact the state Medicaid agency promptly; administrative updates can take time, and the appropriate next step depends on your case.
If you missed Medicare enrollment, get individualized help quickly. Medicare has enrollment periods and special enrollment periods, and late enrollment can create coverage gaps or lasting penalties in some circumstances. A person who lost Medicaid entirely and missed an enrollment opportunity may qualify for a Medicare special enrollment period in certain cases, including Medicaid termination on or after January 1, 2023. (cms.gov)
Bottom line
For most people in this situation, the goal is not to choose between Medicare and Medicaid. It is to make sure both programs are set up correctly. Confirm Parts A and B, keep your Medicaid active if you remain eligible, find out which Medicare costs your state will pay, and provide both insurance cards whenever you receive care.
Frequently asked questions
Do I lose Medicaid when I get Medicare at age 65?
Not necessarily. Many people keep Medicaid after Medicare begins and become dually eligible. Whether you remain eligible for Medicaid depends on your state’s rules and your circumstances. (medicaid.gov)
Does Medicaid pay the Medicare Part B premium?
For people with full-benefit Medicaid, the state pays the monthly Part B premium. People with certain Medicare Savings Programs may also receive Part B premium help. Eligibility is state-specific. (medicare.gov)
Do I need Medicare Part B if I have Medicaid?
Medicare.gov advises people with Medicaid to check with their state when first eligible for Parts A and B. In most cases, enrolling promptly helps avoid gaps or penalties, and Medicaid may pay the Part B premium. Get case-specific guidance before declining Part B. (medicare.gov)
Which card should I show at the doctor’s office?
Bring and show both your Medicare card and Medicaid card. For Medicare-covered services, Medicare generally pays first and Medicaid may pay afterward, if applicable. (medicare.gov)
What if I receive a Medicare deductible or copayment bill?
First, verify your Medicaid category. If you are in QMB, you cannot be billed for Medicare-covered Part A or Part B cost sharing. Contact the provider’s billing office and ask it to rebill correctly; seek assistance from Medicaid or Medicare if needed. (cms.gov)