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Medicare And Medicaid


It is possible to have both Medicaid and Medicaid (Medi-cal in California.) If you have both:

  • Services are covered that are not covered by Medicare. (For a list of services that Medicaid covers listed by state, click here offsite link.)
  • Generally you obtain covered services at no cost. Even if the two payments together do not add up to what the provider wanted, the provider cannot bill you for any deductibles or co insurance normally charged to consumers by Medicare.

As a general matter, the only time you can be billed for a medical service is if it is not covered by Medicaid and the provider informed you of this ahead of time and you consented to paying for the service yourself.

The Background

Medicare provides a limited package of health care benefits and services. Consumers pay premiums, co-payments and deductibles to get Medicare’s services.

Medicaid is a comprehensive package of health care benefits and services that is available at no cost to the eligible consumer. Medicaid covers just about every Medicare covered service plus more.

Medicaid can pay your Medicare premiums, copayments and deductibles, as well as provide additional services.

The Finances

Medicaid can pay any out-of-pocket costs including Part A and Part B premiums, deductibles and coinsurance. Medicaid may also pay for services not covered by Medicare such as dental care, personal care at home, nursing home care or transportation to the doctor.

You may need to enroll in Qualified Medicare Beneficiary Program (QMB) in addition to Medicaid to pay a part B premium. To learn more, see: Medicare: Financial Assistance.

Providers You See

For services that are covered by Medicare, you can see any provider who accepts your Medicare coverage (regardless of whether that doctor participates in Medicaid.

If a service is not covered by Medicare, but is covered by Medicaid, you will need to see a doctor who participates in Medicaid in your state.

How Your Doctors Get Paid

As a rule, your doctors will bill Medicare (Medicare is the primary payor).  If money is owed, your doctor will then bill Medicaid even if your doctor does not participate in Medicaid.

Generally the balance Medicaid will pay depends on what the program would have paid for the entire service if it had been the sole payer.

Medicaid doesn't cover drugs -- you need Medicare drug coverage either through D or Medicare Advantage.

Tip: See doctors and other providers who accept Medicaid -- otherwise you'll have to pay the 20% Medicare co insurance. 

It's better to have Original Medicare than an HMO with Medicaid. "If you join a Medicare HMO, Medicaid will not generally cover your HMO co payments, deductibles or premiums."

You  are automatically enrolled in the Medicare prescription drug benefit -- if you don't choose a drug plan you will be randomly assigned one.

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