Medicaid is health coverage for people with limited income and resources. It is run by each state within federal rules, so the name, the eligibility rules and the services covered vary. Some states call their program by another name, such as Medi-Cal in California.
Many older adults have both Medicare and Medicaid. They are sometimes called "dual eligibles."
How Medicaid helps people with Medicare
If you qualify for both programs, Medicare pays first and Medicaid fills in. Medicaid can:
- Pay your Medicare premiums, deductibles and coinsurance.
- Cover services Medicare does not, which may include some dental, vision and transportation to medical appointments, depending on your state.
- Pay for long-term care, including nursing home care, and in many states care at home.
People with full Medicaid automatically get Extra Help with prescription drug costs.
Eligibility for older adults
Each state sets income and asset limits for older adults, within federal rules. Common pathways include:
- SSI-related coverage. In most states, people who receive Supplemental Security Income qualify for Medicaid.
- Coverage for older adults and people with disabilities with incomes up to a set level.
- Medically needy or "spend-down" programs, in some states, which let people with higher incomes qualify after their medical bills reduce their income below a set level.
- Long-term care Medicaid for nursing home or home-based care, with its own income and asset rules.
Your home, one car, household goods and personal belongings usually do not count as assets, with some limits.
Long-term care through Medicaid
Medicaid is the largest payer of long-term care in the country. It covers nursing home care for people who meet the medical and financial rules, and most states also offer home and community-based services, sometimes through waiver programs, so people can receive care at home or in assisted living.
The five-year look-back
When you apply for long-term care Medicaid, the state reviews gifts and transfers made in the previous five years. Giving away money or property for less than its value during that time can lead to a period when Medicaid will not pay for care.
Protections for spouses
When one spouse needs nursing home care, federal "spousal impoverishment" rules allow the spouse living at home to keep a portion of the couple's assets and some income, so they are not left without means. The protected amounts change every year.
Estate recovery
After the death of a Medicaid recipient who was 55 or older, states must seek repayment from the estate for long-term care costs Medicaid paid. There are protections, such as when a spouse or a minor or disabled child survives. Rules vary by state.
Recent changes
Recent federal legislation adds work or community engagement requirements for some adults ages 19 to 64 who gained coverage through Medicaid expansion, starting by 2027, and more frequent eligibility checks for that group. People 65 and older are not subject to the work requirements. States are still putting these changes into place, so check with your state Medicaid office for the latest rules.
How to apply
Apply through your state Medicaid agency, online, by phone, by mail or in person. You can also apply through the Health Insurance Marketplace at HealthCare.gov, which will send your information to your state. Your Area Agency on Aging or SHIP counselor can help. Read how to find benefits you may qualify for.
Related programs
If your income is a little too high for full Medicaid, you may still qualify for a Medicare Savings Program, which helps with Medicare costs. See Medicare Savings Programs.
