Can You Have Medicare and Medicaid at the Same Time?

Yes, you can have Medicare and Medicaid at the same time, and a person with both is called dually eligible. Medicare pays first for anything it covers, and Florida Medicaid pays last, after Medicare and any other insurance. For a Florida nursing home resident, Medicare covers up to 100 days of skilled care, and Medicaid covers the long-term care after that once the resident qualifies.

This firm works on the long-term care side of Medicaid, meaning nursing homes, assisted living and care at home for older adults. Ordinary Medicaid health coverage for working-age adults and children is a different program with different rules, and nothing on this page is about it.

1. What Does Dual Eligible Mean?

Dual eligible is the federal government’s term for a person who has Medicare and full-benefit Medicaid at the same time. Medicare usually starts at 65 or after a disability, based on a work record. Florida Medicaid for people 65 and older or disabled is called SSI-Related Medicaid, and it depends on income and assets rather than on a work record.

Florida residents who receive Supplemental Security Income are automatically eligible for Medicaid, and the Department of Children and Families says they do not need a separate ACCESS Florida application unless nursing home services are needed. Everyone else applies.

Florida also helps people with limited income pay Medicare costs without full Medicaid, through three Medicare Savings Programs. The Department of Children and Families fact sheet, updated July 2025, describes them this way.

Each of the three programs also brings automatic Extra Help with Medicare drug costs.

2. Which Pays First, Medicare or Medicaid?

Medicare pays first. Medicare’s own site states that for a dual eligible, Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other health insurance the person has. Medicaid is the payer of last resort.

For a family, the order has a practical consequence. A bill goes to Medicare first, then to any other insurance, and then Medicaid looks at what is left. A long-term care policy that pays cash each month also changes the Medicaid math, because a flat cash benefit can count as income. Our guide to the Medicaid share of cost covers how income after eligibility is applied.

3. What Do Medicare and Medicaid Each Pay for a Nursing Home?

Medicare and Medicaid pay for different kinds of nursing home care, one after the other.

Medicare covers the skilled stay only while the resident still needs daily skilled care, and it pays nothing for custodial care, meaning help with bathing, dressing and eating. Our page on whether Medicare covers nursing home care covers those limits.

A resident who is a Qualified Medicare Beneficiary can have Medicaid pay the Medicare coinsurance, within Florida’s limits, during days 21 to 100. Once Medicare stops, Florida Medicaid pays the nursing home through the long-term care program, and the resident pays the nursing home a monthly share from income after keeping $160. A Florida nursing home costs about $10,300 a month for a shared room, which is the bill that falls on the family if the Medicaid application is not ready when Medicare stops. The Florida nursing home cost page has the regional figures.

4. How Do You Get Medicare and Medicaid?

Medicare and Medicaid come from different agencies, so a person applies twice.

1. Medicare. A person signs up through Social Security, usually around 65.
2. Florida Medicaid. A person applies to the Department of Children and Families online at ACCESS Florida, at a Family Resource Center, through a community partner, by phone at 850-300-4323, or on paper. For nursing home care or long-term care at home or in assisted living, the applicant must check the box for HCBS/Waivers or Nursing Home on the Benefit Information screen.

A Medicare Savings Program uses a different form. The Department of Children and Families accepts Medicare Savings Program applications only on a paper Medicaid/Medicare Buy-In application, mailed or faxed to a Customer Service Center. A person who applies to Social Security for Extra Help can ask that the same application be considered for a Medicare Savings Program, and Social Security sends it to Florida.

For long-term care Medicaid, Florida’s 2026 rules for a single applicant are a nursing-home level of care, gross income of $2,982 a month or less, or a qualified income trust if over, and $2,000 or less in countable assets. Our guides to qualifying for Medicaid in Florida and applying for nursing home Medicaid walk through each test, and the eligibility calculator checks the numbers.

5. What Happens to Prescription Drugs and Medicare Plans?

Medicare covers a dual eligible’s prescription drugs. Medicare’s site explains that a dually eligible person is enrolled automatically in a Medicare drug plan, which covers the drugs instead of Medicaid, and that Medicaid may still cover a drug Medicare does not in certain situations. Extra Help with drug costs comes automatically.

A dual eligible still chooses between Original Medicare and a Medicare Advantage plan. Medicare offers special plans for people with both programs, including Special Needs Plans. Florida delivers long-term care Medicaid through a separate long-term care plan chosen through the state’s choice counseling at flmedicaidmanagedcare.com, so a nursing home resident can have one plan for Medicare benefits and another for Medicaid long-term care.

What Does Help With a Medicaid Application Cost?

A Medicaid application, including the eligibility analysis, the verification packet, the filing and the answers to the agency’s requests, is a flat fee from $3,500. A qualified income trust is a flat fee from $750. Crisis planning for a single applicant already in a nursing home is a flat fee from $9,000, and for a married couple the flat fee is quoted at consult. Advertised fees are honored for 90 days from the posted date, and any government costs are additional and passed through at cost.

Frequently Asked Questions

Common Situations

The father on day 40 of rehab. A father in Broward County is in a skilled nursing facility after a hip replacement, and Medicare is paying with a daily copay. The therapists say he will not go home. His daughter files the Medicaid application with the Nursing Home box checked now, so the long-term care coverage is in place by the time Medicare stops.

The widow who pays her own Part B premium. A widow in Ocala has Social Security as her only income and no savings to speak of. She does not need long-term care, but she qualifies for a Medicare Savings Program, so she files the paper Buy-In application and the state starts paying her Part B premium.

Sources of Law

• Medicare.gov, Medicaid (dually eligible defined; Medicare pays first and Medicaid pays last; automatic Medicare drug plan and Extra Help; plans for dual eligibles) and Long-term care (Medicare does not pay for long-term care). Retrieved October 1, 2026.
• Medicare skilled nursing facility coverage, up to 100 days per benefit period after a qualifying three-day hospital stay; 2026 coinsurance of $217 a day for days 21 to 100 (CMS calendar year 2026 rates), as verified on our Medicare nursing home page.
• Florida Department of Children and Families, Medicaid (SSI-Related Medicaid; automatic Medicaid for SSI recipients; ACCESS application and the HCBS/Waivers or Nursing Home box; Medicaid/Medicare Buy-In application) and SSI-Related Medicaid Program Fact Sheet, updated July 2025 (QMB, SLMB, QI-1; Institutional Care Program; $160 personal needs allowance in a nursing facility). Retrieved October 1, 2026.
• Fla. Admin. Code R. 65A-1.702(10)(a) to (b) (QMB coverage of Medicare cost-sharing; SLMB Part B premium); R. 65A-1.713 (income). 2026 figures ($2,982 income cap, $2,000 asset limit) as verified on our eligibility calculator.
• Case retold below: Rosenshein v. Department of Children & Families, 971 So. 2d 837 (Fla. 3d DCA 2007). Opinion read in full; retrieved October 1, 2026.

Why Every Other Payer Has to Go on the Application

In one case I have reviewed, a 94-year-old widow lived in a nursing home in North Miami Beach. Her Social Security of $814.20 a month and her Medicaid both went straight to the nursing home. In 1992 she had bought a long-term care insurance policy (the responsible thing to do, years before she needed it), and the policy paid her about $1,400 a month. On the advice of the nursing home’s business manager, nobody reported the insurance payments to the state.

In 2006 a routine review turned up the policy. The state added the insurance to her Social Security, found her income was $2,260.66 a month against a limit at the time of $1,809, and ended her Medicaid in October 2006. She appealed and lost in 2007. The court explained that a policy paying a fixed amount regardless of the actual nursing home charges is income, while a policy that reimburses actual expenses is not, and it noted that a qualified income trust could have avoided the problem.

In reviewing the Florida cases on how the state counts a resident’s income, I have a few take-home points. The first is the payment order. Medicaid pays last, after Medicare and every other source, so the state treats any money that reaches the resident as part of the picture. Avoid relying on a facility’s business office for advice about what to report, because the facility is not the one whose eligibility is on the line.

The second is the policy language. The practice pointer is to read the policy before applying, to see whether it pays a flat daily or monthly amount or reimburses actual charges, because the answer decides whether the benefit counts as income. Where a flat benefit pushes income over Florida’s 2026 cap of $2,982 a month, a qualified income trust set up in advance keeps the resident eligible. One limit is worth stating plainly. The court did not decide whether the widow later regained Medicaid with a trust, so the opinion does not tell us how her story ended.

Kevin D. Klagge, Esq., admitted in Florida since 2012. The case described above is a decision of a Florida court rather than a matter handled by this firm. Past results do not guarantee a similar outcome.

Updated on October 1, 2026. Reviewed by Kevin D. Klagge, Esq., Fla. Bar No. 99502. Attorney Kevin Klagge represents families, businesses, and international clients in estate and tax planning, business structuring, and international law, with a focus on Florida legal tools. He litigates estate and business issues in court. General information about Florida law, not legal advice, and no attorney-client relationship is created. Do not send confidential information until we have agreed to represent you.