Medicare and Medicaid Together: Who Pays First and How

When you have both Medicare and Medicaid, Medicare pays first for covered care, and Medicaid pays second. Medicaid can then help with costs Medicare leaves, such as premiums, deductibles and coinsurance. It may also pay for care Medicare does not cover, like long-term nursing home care.

Key takeaways

• Medicare pays first for services both programs cover. Medicaid pays last.
• Your drug coverage comes from Medicare Part D, not Medicaid.
• With full Medicaid, you get Extra Help with drug costs automatically.
• How much Medicaid pays depends on your level of help and your state.
• People with Medicaid can change drug plans once a month.

What does it mean to be dual eligible?

Being dual eligible means you have both Medicare and Medicaid. Medicare is federal health insurance for people 65 and older and some younger people with disabilities. Medicaid is a joint federal and state program for people with limited income and resources.

There are two main levels. Full Medicaid gives you Medicaid health benefits plus help with Medicare costs. Partial help comes through Medicare Savings Programs (state programs that pay some Medicare costs), without full Medicaid benefits.

Each state runs its own Medicaid program. Income and resource limits, and some benefits, vary by state. Your state Medicaid office decides whether you qualify.

You apply for Medicaid and for Medicare Savings Programs through your state Medicaid office, online, by phone or in person. Have proof of your income, bank balances and any other savings ready when you apply.

Who pays first, Medicare or Medicaid?

Medicare pays first for services it covers. Medicaid is the payer of last resort, which means it pays only after Medicare and any other insurance have paid.

Here is how a doctor visit works. The doctor bills Medicare first. Medicare pays its share. Then the doctor bills Medicaid for what is left, such as your Part B coinsurance. For this to work, your doctor must accept both Medicare and Medicaid. If a doctor does not take Medicaid, Medicaid may not pay its share. Ask each office whether it accepts both before your visit.

The table shows the pattern. Medicare handles most medical care first, and Medicaid fills gaps and covers long-term care.

What can Medicaid pay for you?

With full Medicaid, your state usually pays your Part B premium. The 2026 standard Part B premium is $202.90 a month; it is set each year. Medicaid can also pay deductibles, like the 2026 Part B deductible of $283 and the 2026 Part A deductible of $1,736 per benefit period.

Medicaid may cover services Medicare does not. These can include long-term nursing home care, personal care at home, and rides to medical visits. Some states also cover dental or vision care. These extras vary by state.

One Medicare Savings Program, QMB (the Qualified Medicare Beneficiary program), pays Part A and Part B premiums, deductibles and coinsurance. If you are in QMB, providers who take Medicare cannot bill you for those Medicare costs.

How does drug coverage work?

Your prescription drugs are covered by Medicare Part D, not Medicaid. If you do not pick a drug plan, Medicare signs you up for one. You can switch to a different plan if it fits your drugs better. See Medicare Part D: Your Prescription Drug Coverage Choices.

With full Medicaid, a Medicare Savings Program or Supplemental Security Income, you get Extra Help automatically. In 2026, Extra Help copays are at most $5.10 for a generic drug and $12.65 for a brand-name drug. Some people with Medicaid pay less. Learn more in Extra Help: Do You Qualify.

People who get Extra Help pay no Part D late enrollment penalty. Medicaid may still cover a few drugs that Part D does not, depending on your state.

Can you change plans more often?

Yes, but only in certain ways. Since January 1, 2025, people with Medicaid or Extra Help have a special enrollment period once each calendar month. A special enrollment period is a time outside the usual windows when you can change plans.

This monthly window lets you join or switch a stand-alone Part D drug plan. You can also use it to leave a Medicare Advantage plan for Original Medicare plus a stand-alone drug plan. It does not let you join or switch Medicare Advantage plans.

If you have full Medicaid, there is one more option. You can switch once a month into an integrated D-SNP (a Medicare Advantage plan for people with both Medicare and Medicaid) run by the same company as your Medicaid plan.

What is a dual eligible special needs plan?

A D-SNP, or dual eligible special needs plan, is a Medicare Advantage plan only for people with both Medicare and Medicaid. It works to coordinate your Medicare and Medicaid benefits in one plan.

Many D-SNPs include drug coverage and extra benefits, such as dental, vision or rides to care. Some are integrated, which means the same company also runs your Medicaid plan. Benefits, networks and costs vary by plan, location and carrier.

You can also keep Original Medicare with a stand-alone Part D plan. Both paths use Medicaid to help with costs. For how the two main paths differ, see Original Medicare vs. Medicare Advantage.

What should you keep track of?

Keep your Medicare card, your Medicaid card and any plan cards together. Show all of them at every visit and at the pharmacy. This lets each office bill the right program in the right order.

Medicaid usually reviews your eligibility each year. Open and answer any letter from your state Medicaid office quickly. If you miss a renewal, your Medicaid and the help with Medicare costs can stop.

If a bill arrives for costs Medicaid should pay, call the provider. Tell them you have both Medicare and Medicaid, or QMB, and ask them to bill Medicaid.

If you move to another state, your Medicare goes with you, but your Medicaid does not. You must apply for Medicaid again in your new state.

Have questions? Call 1-877-443-3251 to talk it through with a licensed insurance agent. You never pay the agent; the plans they represent do, and the decision stays yours.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.