Applying for Medicare and Medicaid Together: Step-by-Step Guide

Copayments. Deductibles. Premiums. If you're at least 65 and living on a low fixed income, you know how quickly health care expenses can stack up. Qualifying for both Medicare and Medicaid may help ease that burden by expanding your coverage and lowering your out-of-pocket costs.

People who qualify for both programs are called dual eligible. You can apply for Medicare and Medicaid at the same time, but the programs usually have separate applications. You apply for Medicare through the Social Security Administration and for Medicaid through your state Medicaid agency. 

How do you know if you’re dual-eligible, and where do you begin? This guide explains how to check your eligibility, gather the necessary documents, apply for Medicare and Medicaid, and get help along the way.

What is Medicare-Medicaid dual eligibility? Who qualifies?

Being dual eligible means you qualify to enroll in both Medicare and Medicaid at the same time. Medicare acts as the primary payer, covering hospital stays, doctor visits, and other health care services as shown below:

• Part A (Hospital Insurance): Pays for hospital stays as well as short-term stays at skilled nursing facilities
• Part B (Medical Insurance): Covers doctor visits, outpatient hospital care, and home health care services not covered by Part A
• Part D (Prescription Drug Coverage): A separate plan from a private insurer that helps pay for prescription medications

Where does Medicaid come in? For dual-eligible older adults, Medicaid acts as a second layer of coverage. It steps in to help with costs Medicare doesn’t fully cover—such as premiums, copays, long-term nursing home care, and even routine dental care, hearing aids, and eyeglasses. Without Medicaid, you would be responsible for these costs out of your own pocket.

Before you apply for dual Medicare and Medicaid, you should take the time to understand the programs’ eligibility guidelines. Medicare eligibility is based on age, disability status, and having certain medical conditions. With Medicaid, you must have limited income and assets to qualify.

Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits, recommends that all older adults with low income check if they’re dual eligible. “For people with very low income, dual eligible status can bring a lot of financial relief,” he explained.

What’s more, adults who are fully dual eligible automatically qualify for the Part D Low Income Subsidy, or Extra Help. This is a key benefit that helps pay for prescription medications, worth about $5,700 per year,” Ramsey said.

How do I apply for Medicare-Medicaid dual enrollment?

As someone who is dual eligible, claiming your benefits generally requires you to apply to each program separately. Here's how to do both.

Step 1: Apply for Medicare

You are eligible for Medicare if you are age 65 or older. You might qualify before age 65 if you have a disability, permanent kidney failure (End-Stage Renal Disease), or ALS (Lou Gehrig’s disease).

How do I apply for Medicare?

There are three basic ways to apply for Medicare:

• Apply online: Visit SSA.gov/Medicare.
• Apply by phone: Call the Social Security Administration (SSA) at 1-800-772-1213.
• Apply in person: Visit your local Social Security office. Note that you may need an appointment before visiting an office in person and this option could take longer than if you were to use SSA's website.

Are you already receiving Social Security benefits? There’s no need to file a separate application; you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Approximately three months before your birthday, you’ll receive your red, white, and blue Medicare card in the mail.

Step 2: Apply for Medicaid

You may qualify for Medicaid if you have limited income and assets that fall within your state’s specific guidelines. In most states (but not all), if you receive Supplemental Security Income (SSI), you’ll be automatically enrolled. This means you may not need to submit a separate Medicaid application (but it’s still smart to confirm with your local Medicaid office).

Also, if you’re interested only in getting help with your Medicare out-of-pocket costs through one of the Medicare Savings Programs (this is called “partial dual eligibility”), you do not need to file a separate Medicaid application. Instead, the Medicare Savings Program (MSP) application doubles as your Medicaid application for those specific benefits. Depending on which plan you’re enrolled in, an MSP can put thousands of dollars back into your budget for everyday needs like groceries and utilities. Three of the four MSPs cover the Medicare Part B premium—saving you $202.90 per month in 2026, or $2,434.80 per year. Plus, MSP enrollment automatically qualifies you for the Part D Extra Help benefit, which provides additional yearly savings.

Those interested in full Medicaid benefits and Medicare (this is called “full dual eligibility”) must file a separate Medicaid application.

How do I apply for Medicaid?

There are several ways to apply for Medicaid:

• Apply online: Visit your state’s Medicaid website or go through the Health Insurance Marketplace.
• Apply by phone: Call your state Medicaid office.
• Apply in person: Visit your local Medicaid or social services office.

What happens after I apply for Medicaid?

Once you submit your Medicaid application, your state agency will review your income, assets, and other eligibility factors. You may be asked to provide supporting documents such as:

• Proof of birth date (e.g., birth certificate)
• Proof of U.S. citizenship or lawful residence (e.g., driver's license, passport, green card)
• Proof of residence (e.g., deed, rent receipts) 
• Proof of earned and unearned income (e.g., pay stubs, Social Security benefits statement)
• Proof of assets (e.g., bank statements, life insurance policies)
• Your Medicare card (and any other insurance cards)

A Medicaid decision typically takes up to 45 business days, though many states will process applications faster. If your application is approved, you’ll receive a decision notice confirming your Medicaid enrollment and how much you’ll have to pay toward your costs (cost sharing).

If you apply for dual Medicare and Medicaid and your Medicaid application is denied, you’ll get a letter explaining the reason—and how to appeal the decision.

You can check your application status anytime by contacting your state Medicaid agency.

What if my Medicaid application is denied?

Don’t give up. Many older adults are approved for Medicaid after appealing or exploring other options. It’s important to advocate for yourself (or an older adult you care for).

Here are some actions you can take:

• Request a fair hearing: Follow the instructions provided in your denial notice. You often have 30 days to request a Medicaid fair hearing (but some states allow up to 90 days).
• Explore Medicaid spend-down programs: If your income is slightly above the limit, you may qualify for a Medicaid spend-down program (also called Medically Needy Medicaid). This involves using your medical bills to “spend down” to the income level that meets Medicaid eligibility requirements.
• Ask about Medicaid waiver programs: Offered by nearly all states, Medicaid waivers can expand access to medical and non-medical services (e.g., home health care, meal delivery, transportation) even if your income or assets are higher than your state’s limits.

Explore more options if your income is too high for full dual eligibility.

Frequently asked questions (FAQ)

Can I apply for Medicare and Medicaid online?
Yes. You can apply for Medicare online through the Social Security Administration at SSA.gov/Medicare. To apply for Medicaid, visit your state Medicaid agency’s website or HealthCare.gov. Medicare and Medicaid usually require separate applications.

Am I automatically enrolled in Medicaid if I receive SSI?
In most states, receiving Supplemental Security Income (SSI) automatically qualifies you for Medicaid. But some states require a separate Medicaid application or use additional eligibility rules. Contact your state Medicaid agency to confirm your enrollment.

How do I check the status of my Medicaid application?
You can easily check your Medicaid application status through your state’s online benefits portal or by contacting your state Medicaid agency. Have your application or confirmation number ready. If you applied through HealthCare.gov, you can also check your Marketplace account for updates.

Need help applying for dual Medicare and Medicaid?
With so many rules and requirements to sift through, navigating both of these programs can seem complicated. But help is yours for the asking.

Medicare.gov and your state Medicaid agency are good resources for expert information and guidance. You can also contact your State Health Insurance Assistance Program (SHIP) for trustworthy advice. SHIP counselors are well-versed in how to apply for dual Medicare and Medicaid coverage. They can tell you if you meet eligibility requirements and, if you do, walk you through the application process for each program step by step.

Learn More: What Is the Income Limit for Dual Medicare and Medicaid?