What should my client do if they have Medicaid and then turn 65 and become eligible for Medicare?

Assess the client’s eligibility to remain on Medicaid once they turn 65. State Medicaid programs may have different eligibility criteria depending on age.

As long as the client meets the eligibility criteria for both Medicaid and Medicare (also known as dual eligibility), they are able to receive coverage from both programs. A few common scenarios may include:

• If the client was eligible for Medicaid under the Affordable Care Act (ACA) Medicaid expansion group (i.e., individuals up to 138% of federal poverty level), that coverage ends when the client turns 65 and they transition to Medicare. However, the client may still be eligible for other Medicaid eligibility categories in addition to Medicare and will be reassessed for other Medicaid eligibility categories before they turn 65. (Note: this process was different during the COVID-19 pandemic when Medicaid programs were prohibited from terminating coverage, see the question below for more information). The client may also be eligible for a Medicare Savings Program, where Medicaid can help pay for their Medicare premium and reduce their cost-sharing obligations. 
• If the client is under 65 and enrolled in Medicaid based on another eligibility category (e.g., disability), and then becomes eligible for Medicare when they turn 65, they may continue to be eligible for full Medicaid coverage (depending on the state) in addition to being eligible for Medicare. Some state Medicaid programs end Medicaid coverage at age 65, and clients should check in with their state Medicaid programs to understand eligibility rules. Dually eligible clients may be entitled to some Medicaid services that Medicare does not cover. As stated above, even if the client is no longer eligible for another full Medicaid eligibility category, they may still be eligible for a Medicare Savings Program to help with Medicare costs. If a client was enrolled in Medicaid and Medicare and subsequently loses Medicaid coverage, they are eligible for a Special Enrollment Period to pick a Medicare Advantage plan or to enroll in traditional Medicare. This is because they will no longer be eligible for a specific type of Medicare Advantage plan only available to dually eligible enrollees called a Dual Eligible Special Needs Plan (D-SNP).