Medicare generally pays first for Medicare-covered services. Medicaid pays after Medicare and other health insurance and may cover additional services, depending on the state and eligibility category.
What “dually eligible” means
Medicare calls people with Medicare and full-benefit Medicaid coverage “dually eligible.” Some people instead receive limited Medicaid help with Medicare costs through a Medicare Savings Program. The benefits are not identical in every category.
Which program pays first
For a service Medicare covers, Medicare is generally the primary payer. Medicaid is the payer of last resort after Medicare and other insurance. A provider still must participate under the rules that apply to the coverage.
Prescription drug coverage
For people with both programs, Medicare generally provides prescription drug coverage through Part D. Medicaid may cover certain drugs Medicare does not cover in limited circumstances. Read the plan and state notices before changing coverage.
Coverage choices can differ
A dually eligible person may use Original Medicare or, when eligible, choose a Medicare Advantage option. Some areas offer Dual Eligible Special Needs Plans that coordinate Medicare and Medicaid services. Availability, provider networks, covered extra services, and state Medicaid arrangements vary.
How to apply
Medicare and Medicaid are separate programs. Apply for Medicaid or a Medicare Savings Program through the official state or territory Medicaid agency. The agency decides eligibility under the rules that apply there; Medicare does not make the state Medicaid decision.