How to Switch From Medicare to Medicaid

Changing from Medicare to Medicaid is possible for individuals who need more extensive healthcare coverage. To start the process, contact your local Medicaid office to inquire about eligibility. Depending on your state of residence, there might be specific income and asset limits you need to meet. Once you have determined your eligibility, you can apply for Medicaid benefits through the appropriate channels, such as online, via mail, or in person at a designated location. If approved, your Medicaid coverage will begin on a specified date, and you will receive a Medicaid card that serves as proof of your enrollment. Remember that transitioning from Medicare to Medicaid may affect your current benefits and coverage, so it’s crucial to carefully consider your situation and consult with healthcare professionals to ensure a smooth change.

Understanding Eligibility Requirements

Eligibility for switching from Medicare to Medicaid varies by state and is determined by factors such as income, assets, and health status. Generally, individuals must meet the following criteria:

  • Be a citizen or qualified non-citizen of the U.S.
  • Meet the age requirement for Medicare (65 or older, disabled, or with end-stage renal disease).
  • Meet income and asset limits set by your state’s Medicaid program.
  • Depending on your state, you may need to meet additional requirements, such as having a disability or being in a nursing home.

Medicaid Programs That Cover Dual-Eligible Individuals

Individuals eligible for both Medicare and Medicaid are considered “dual-eligible” and have various Medicaid programs available to them:

  • Full Medicaid Coverage: Provides full coverage for all medically necessary services, including Medicare Part A and B benefits.
  • Medicare Savings Programs (MSPs): Offers financial assistance to help pay Medicare premiums, deductibles, and coinsurance.
  • Qualified Medicare Beneficiary (QMB) Program: Provides full Medicaid coverage to individuals who pay their Medicare premiums.
Medicaid Programs for Dual-Eligible Individuals
Program Coverage Financial Assistance
Full Medicaid Coverage All medically necessary services, including Medicare Part A and B benefits None
Medicare Savings Programs (MSPs) Help with Medicare premiums, deductibles, and coinsurance Varies depending on income and assets
Qualified Medicare Beneficiary (QMB) Program Full Medicaid coverage Individual must pay Medicare premiums

To apply for Medicaid to switch from Medicare, contact your state’s Medicaid office or visit the Centers for Medicare & Medicaid Services (CMS) website. You can also seek assistance from a local agency that helps people with Medicare and Medicaid.

It’s important to note that switching from Medicare to Medicaid may affect your coverage and benefits. However, Medicaid can provide comprehensive coverage for individuals with limited income and assets, ensuring access to necessary healthcare services.

Eligibility for Medicaid and Medicare

Medicare is a health insurance program for people aged 65 or older, people with disabilities, and people with end-stage renal disease. Medicaid is a health insurance program for people with low income and limited resources. To qualify for Medicaid, you must meet certain income and asset limits. In most states, you must also be a U.S. citizen or a legal resident.

Filing an Application

To apply for Medicaid, you can contact your state’s Medicaid office or apply online. You will need to provide information about your income, assets, and household size. You may also need to provide proof of your U.S. citizenship or legal residency.

Once you have applied for Medicaid, you will be assigned a caseworker who will review your application and determine if you are eligible. If you are approved for Medicaid, you will receive a Medicaid card that you can use to get health care services.

Using Medicaid and Medicare Together

If you are eligible for both Medicaid and Medicare, you can use both programs to get health care coverage. Medicare will pay for most of your medical expenses, and Medicaid will pay for any remaining expenses that Medicare does not cover. You can also use Medicaid to get long-term care services, such as nursing home care or home health care.

If you are eligible for both Medicare and Medicaid, you will need to coordinate your benefits so that you do not end up paying for the same services twice.

Switching From Medicare to Medicaid

If you are currently enrolled in Medicare and you become eligible for Medicaid, you can switch from Medicare to Medicaid. To do this, you will need to contact your state’s Medicaid office and apply for Medicaid. Once you are approved for Medicaid, your Medicare benefits will end.

Switching from Medicare to Medicaid can have some financial consequences. For example, you may have to pay higher copayments for services under Medicaid than you did under Medicare. You may also lose access to some Medicare benefits, such as Medicare Part D prescription drug coverage.

Things to Consider Before Switching From Medicare to Medicaid

Before you decide to switch from Medicare to Medicaid, you should carefully consider the pros and cons. Here are some things to think about:

  • Pros of switching from Medicare to Medicaid:
    • Lower copayments and deductibles
    • More comprehensive coverage, including long-term care services
  • Cons of switching from Medicare to Medicaid:
    • Loss of access to some Medicare benefits, such as Medicare Part D prescription drug coverage
    • Potential for higher out-of-pocket costs, such as copayments and deductibles
    • Potential for delays in getting care


Switching from Medicare to Medicaid is a major decision that can have a significant impact on your health care coverage and your finances. Before you make a decision, you should carefully consider the pros and cons of switching and talk to your doctor and your financial advisor.

Comparison Table of Medicare and Medicaid

Program Eligibility Benefits Costs
Medicare People aged 65 or older, people with disabilities, and people with end-stage renal disease Hospital coverage, medical coverage, prescription drug coverage Monthly premiums, deductibles, and copayments
Medicaid People with low income and limited resources Hospital coverage, medical coverage, long-term care services No premiums, low deductibles and copayments

Medicare and Medicaid: Understanding the Differences

Medicare and Medicaid are two distinct government-sponsored health insurance programs in the United States, each serving different purposes and targeted populations. Medicare primarily provides coverage for individuals aged 65 and over, certain younger individuals with disabilities, and individuals with End-Stage Renal Disease (ESRD). In contrast, Medicaid is a joint federal and state program that provides health insurance coverage to low-income individuals, families, and certain disabled individuals. Understanding the distinctions between these programs is crucial when considering a transition from one to the other.

Understanding Eligibility Criteria

Medicare Eligibility

  • Age 65 or older
  • Individuals under 65 with certain disabilities
  • Individuals with ESRD

Medicaid Eligibility

  • Low-income individuals and families
  • Certain disabled individuals
  • Eligibility criteria vary by state

Transition from Medicare to Medicaid: A Step-by-Step Guide

  1. Research and Gather Information:
    • Contact the local Medicaid office or visit their website to determine eligibility.
    • Gather necessary documents, such as proof of income, assets, and residency.
  2. Apply for Medicaid:
    • Complete the Medicaid application form, typically available online or in person at the Medicaid office.
    • Submit the application along with the required documents.
    • Await a decision on your eligibility.
  3. Notify Medicare:
    • Once you receive confirmation of Medicaid eligibility, notify the Social Security Administration (SSA).
    • You can do this by calling the SSA or visiting their website.
    • Provide your Medicare information, including your Medicare number and date of birth.
  4. Plan Your Transition:
    • Coordinate with your doctors and healthcare providers to ensure a smooth transition.
    • Ensure your current medications are covered under Medicaid.
    • Research and locate healthcare providers who accept Medicaid in your area.
  5. Complete the Transition:
    • Your coverage under Medicare will end on the last day of the month in which you become eligible for Medicaid.
    • Your Medicaid coverage will begin on the first day of the following month.

Timeline and Considerations

The transition process from Medicare to Medicaid typically takes a few weeks or months, depending on state processing times and individual circumstances. It is essential to plan for a smooth transition, ensuring you have access to necessary medications and healthcare services throughout the process. Additionally, consider consulting with a healthcare professional or an experienced insurance agent to address any specific questions or concerns you may have.

Key Points to Remember
Medicare Medicaid
Age 65+ or disabled Low-income individuals and families
Federally administered Joint federal and state program
Medicare Part A (hospital insurance) is typically premium-free Premiums may apply, depending on state and individual circumstances
Medicare Part B (medical insurance) has monthly premiums Co-payments and deductibles may apply

Transitioning from Medicare to Medicaid can be a complex process, requiring careful planning and consideration. By understanding the eligibility criteria, following the outlined steps, and staying informed about potential changes, individuals can navigate the transition successfully and maintain access to essential healthcare coverage.

Risks That May Arise Post Switching

Switching from Medicare to Medicaid may introduce certain risks that individuals should be aware of:

  • Reduced Coverage: Medicaid typically offers a narrower range of benefits compared to Medicare. This means that certain services or treatments covered under Medicare may not be covered under Medicaid.
  • Provider Network Changes: Medicaid has its own network of providers, which may differ from the providers accepting Medicare. Switching to Medicaid may require finding new healthcare providers within the Medicaid network.
  • Medication Changes: Medicaid may have different formularies, or lists of covered drugs, compared to Medicare. This could result in changes to the medications an individual is taking, potentially affecting their treatment.
  • Impact on Other Benefits: Switching to Medicaid may affect other government benefits, such as Supplemental Security Income (SSI) or housing assistance. It’s important to understand how the change in insurance coverage may impact these benefits.

Ways to Mitigate Risks After Switching

To minimize the risks associated with switching from Medicare to Medicaid, individuals can take the following steps:

  • Research and Preparation: Before switching, thoroughly research the Medicaid program in their state to understand the coverage, benefits, and limitations. This information can help individuals make informed decisions.
  • Consult Healthcare Providers: Discuss the switch with healthcare providers to understand how it may affect their treatment. Providers can provide guidance on the potential impact on medications, treatments, and access to specialists.
  • Review Medication Coverage: Check the Medicaid formulary to determine if the medications an individual is taking are covered. If there are changes, discuss alternative options with healthcare providers.
  • Explore Supplemental Coverage: Consider purchasing Medicare supplemental insurance (Medigap) or other supplemental health insurance plans to fill gaps in coverage under Medicaid.
  • Stay Informed: Keep up-to-date with changes in Medicaid coverage and policies. This can help individuals stay informed about any updates that may affect their healthcare.

Table: Comparing Medicare and Medicaid

Medicare vs. Medicaid
Medicare Medicaid
Eligibility Individuals aged 65 or older, those with certain disabilities, or those with End-Stage Renal Disease (ESRD) Individuals with low income, pregnant women, children, and individuals with certain disabilities
Coverage Parts A (hospital insurance), B (medical insurance), C (Medicare Advantage), and D (prescription drug coverage) Varies by state, but generally includes comprehensive medical care, hospital stays, doctor visits, and prescription drugs
Costs Part A is mostly premium-free, Part B has a monthly premium, Part C and D have varying premiums and costs Premiums and cost-sharing vary by state and individual circumstances
Provider Network Healthcare providers who accept Medicare Healthcare providers who accept Medicaid
Eligibility Verification Individuals provide their Medicare card and other relevant information Individuals must provide income and asset information to determine eligibility

Well, folks, there you have it – a step-by-step guide to switching from Medicare to Medicaid. I know it can be a lot to take in, so if you have any questions, be sure to reach out to your local Medicaid office. And that’s all she wrote, folks! Thanks for sticking with me through this adventure. Be sure to visit us again soon. We’ve got all sorts of other helpful articles and resources to make your Medicare experience a breeze. Until next time, keep those golden years shining!