This story is a part of KERA Health Check-ups. More information is available at the end of the article.
Medicaid and Medicare are publicly funded programs that provide coverage to certain vulnerable populations – but a KERA listener with Medicare coverage wanted to know if they could also be eligible for Medicaid.
The short answer: yes.
“Having Medicare does not mean that Medicaid it off the table,” said Daniel Bouton, the vice president of health and wellness for the United Way of Metropolitan Dallas.
People can be dually eligible for both Medicare and full Medicaid coverage. Typically, Medicaid pays last – meaning if an enrollee has Medicare or other insurance coverage, those programs or plans pay first.
Differences between programs
Bouton said the biggest difference between Medicare and Medicaid is how eligibility is determined.
Medicare is a federally funded program for people who are over the age of 65, but some people younger than that may still be eligible if they have certain disabilities or health conditions.
In 2024, almost 5 million Texans were enrolled in Medicare, according to data analysis from KFF.
Eligibility is less straightforward for Medicaid.
The joint state and federal program provides coverage to certain groups of people with low incomes.
Traditional Medicaid populations – people over 65 and people with certain disabilities – are covered in every state. Coverage beyond that point is up to the state government, so eligibility can vary.
In Texas – one of 10 states that haven’t adopted full Medicaid expansion – the program covers children, pregnant people and caregivers of children or adult relatives. Eligibility for those populations is based on how the family’s income compares to the federal poverty level. For example, adult caregivers are covered if they make less than 12% of the federal poverty level and pregnant people are covered if they make less than 198% of the federal poverty level.
Almost 4 million Texans were enrolled in Medicaid as of this June.
Applying for programs shouldn’t impact the coverage you currently have
Dual eligibility is allowed, as long as the person meets the requirements for both Medicare and their state’s Medicaid program.
“Medicaid will provide additional assistance for those pieces that are not covered under Medicare,” Bouton said.
Bouton said there’s no harm in applying to see if you might be eligible for Medicaid if you already receive Medicare.
“We always encourage, explore your options,” he said. “Let’s submit an application to the [Texas] Health and Human Services Commission. Let them determine your eligibility.”
Even if someone doesn’t qualify for full Medicaid coverage, Bouton said it’s common for the people his organization helps to find out they qualify for different savings programs that help with the cost of care.
“Many of our patients are always pleasantly surprised that they qualify for things that they didn’t know they qualify [for],” he said. “We know the cost of care right now is high. It’s important for individuals to…see what additional services they qualify for and to take care of their health.”
Resources for people applying for coverage
The application process for Medicaid involves some additional steps and documentation.
“When applying for Medicaid, we do report financial resources and individual circumstances,” Bouton said. “Do I have a savings account? Do I have an investment here or there? All of that needs to be recorded.”
While the differences in eligibility can be confusing, Bouton said there are organizations designed to help people understand and navigate applications for both Medicare and Medicaid.
To find healthcare assister organizations, people can go to healthcare.gov’s Find Local Help tool and type in their zip code.
Bouton’s organization has several healthcare navigators who are trained to provide unbiased assistance to people trying to apply for different programs or trying to choose between different plans. He said navigators can help people use yourtexasbenefits.com to explore what social support programs they may qualify for.
“Reach out,” he said. “Seek help, and we’re ready to always provide assistance.”
This story was inspired by a KERA audience member as part of KERA Health Check-ups. Health Check-ups are designed to answer KERA listener questions about health topics and make the complicated world of health policy and access more understandable. If you have a question for our health reporter or want to help shape KERA’s health coverage, fill out this form.
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