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How Medicare and Medicaid Work Together: Who Pays What, and in What Order

Medicare and Medicaid are two different programs, and many people have both. Here is how they really fit together: who pays first, what each one covers, and what you still have to do.

Medicare7 min readReviewed 2026-10-16

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Short answer

Medicare is federal health insurance, mainly for people 65 and older and some people with disabilities. Medicaid is a joint federal and state program for people with limited income and resources, and its rules are different in each state. When you have both, you are 'dually eligible.' Medicare pays first for services it covers, and Medicaid pays last, after Medicare and any other insurance. Medicaid can also cover things Medicare does not, such as nursing home care and personal care.

Use this before you call.

Have both Medicare and Medicaid, or think you might qualify? Call GetFastRates.com and a licensed agent will explain your options.

Check whether you may qualify for Medicaid or a Medicare Savings Program by contacting your state's Medicaid office.

Even if you do not think you qualify, apply. States count income and resources differently.

Keep both your Medicare card and your Medicaid card, and show both at every visit.

Choose how to get your Medicare coverage: Original Medicare with a drug plan, or a Medicare Advantage plan, including plans designed for people with Medicaid.

Watch your mail for Medicaid renewal notices and report changes in income or address.

Call us if you want to see which Medicare plans fit your doctors, prescriptions and Medicaid.

The short version

Medicare covers health care for people 65 and older and some younger people with disabilities. Medicaid helps people with limited income and resources, including some older adults, and covers some things Medicare does not. You can have both at once. Medicare pays first, then Medicaid pays what it is responsible for, and Medicaid is always the last payer.

Two kinds of 'both'

People with Medicare and Medicaid fall into two broad groups, and which one you are in changes what is paid for.

Full-benefit dual eligible: you have Medicare and full Medicaid coverage. Your state pays your Part B premium and, depending on your level of Medicaid, may pay your Medicare deductibles, coinsurance and copayments and some other costs.
Medicare Savings Program only: Medicaid does not give you full coverage, but your state helps with some Medicare costs such as the Part B premium. These are the QMB, SLMB, QI and QDWI programs.

A realistic example

You see a doctor. Medicare pays its share first. If you have full Medicaid or the Qualified Medicare Beneficiary program, Medicaid may then cover your share of the cost, and the provider is not allowed to bill you for the Medicare deductible, coinsurance or copayment. You may owe a small Medicaid copayment if one applies. For care Medicare does not cover, like long-term nursing home care or personal care, Medicaid may pay if you qualify under your state's rules.

Prescriptions: Medicare drug coverage pays for your drugs, not Medicaid. People with Medicaid automatically get Extra Help with drug costs.
Hospital stays and doctor visits: Medicare pays first, and Medicaid may cover cost sharing.
Things Medicare does not cover, such as nursing home care and personal care services: Medicaid may cover them if you qualify.

What you still have to do

Having both programs does not mean everything happens automatically.

Show both cards when you get care, so providers bill in the right order.
Medicaid eligibility is reviewed regularly, so open your renewal mail and answer by the deadline.
Tell your state about changes in income, household or address. Losing Medicaid can change your Extra Help and how much you pay.
If you get a bill for a Medicare-covered service and you are in a Medicare Savings Program like QMB, call 1-800-MEDICARE before paying.

Choosing Medicare coverage when you have Medicaid

You can still choose Original Medicare or a Medicare Advantage plan. If you choose Medicare Advantage, there are special plans for people with both programs that coordinate care, include Medicare drug coverage and may cost less, such as Special Needs Plans, Medicare-Medicaid Plans (only available in certain states) and the Program of All-Inclusive Care for the Elderly. People with Medicaid or Extra Help may also have more chances during the year to change plans than other people, so ask before assuming you have to wait.

Common questions about this topic

Does Medicaid replace Medicare?

No. When you have both, Medicare is your main insurance for the services it covers and Medicaid fills in behind it.

Do I need a Medicare supplement (Medigap) policy if I have Medicaid?

It depends on your level of Medicaid and your state. Talk to your state Medicaid office or your State Health Insurance Assistance Program before you buy or drop any supplement policy.

Who pays my Part D drug costs?

A Medicare drug plan covers your drugs, not Medicaid, and you automatically get Extra Help with those costs. Medicaid may still cover a drug in certain situations if Medicare does not.

Where do I apply?

For Medicaid and the Medicare Savings Programs, contact your State Medical Assistance (Medicaid) office. These are run by your state, not by Social Security.

Tools that can help

Medicare Enrollment Period CalculatorFind your Medicare enrollment window and what it means for your timing.Medicare Part B Late Enrollment Penalty CalculatorEstimate whether a Part B late enrollment penalty could apply to you.Medicare Plan Ending FinderCheck your carrier and ZIP code against current, verified plan-ending records.

Trusted public sources

These links are provided for general public information. They do not replace a personal coverage review.

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