I have both Medicare and Medicaid. Who pays first, and what do I still pay?

Health insuranceWho paysChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Medicare.gov · Who pays first? View original ↗

In short

Medicare pays first. Medicaid pays after.
In most cases, your state pays your Part B premium.
Medicare covers your drugs. If you do not pick a plan, Medicare picks one.

What this means

Medicaid never pays first for services Medicare covers [1]. Medicare pays first, then Medicaid may pay what is left, under your state's rules.

Premiums: most people with Medicaid do not pay a Part A premium. In most cases, your state pays your monthly Part B premium while you have Medicaid [2].

Drugs: Medicare covers your drugs. You need a Medicare drug plan or a health plan with drug coverage. If you do not join one, Medicare will enroll you in one [1]. With full Medicaid in a nursing home, you pay nothing for covered drugs [1].

Plans: companies generally cannot sell you a Medigap policy if you have Medicaid [3]. You may be able to join a Dual Eligible Special Needs Plan (D-SNP). These plans work with your state Medicaid program to coordinate both sets of benefits [4].

Your next step

Show both your Medicare card and your Medicaid card at every visit. If you are still paying a Part B premium, ask your state Medicaid office if it should be paying it. The sources give no deadline.

Check it yourself

Your state Medicaid office can confirm which Medicaid type you have (full or partial). What you pay for a service after Medicare — "Don't know yet"; it depends on your state and your Medicaid type.

Where this comes from (4)

[1] Medicare.gov · Who pays first? · checked 2026-11-06
Medicaid never pays first for services Medicare covers. In rare cases where there’s other coverage besides Medicare, Medicaid pays after the other coverage has paid. … Medicare will cover your drug costs. You'll need to join a separate Medicare drug plan or a health plan with Medicare drug coverage for Medicare to pay for your drugs. … If you don't join a drug plan, Medicare will enroll you in one to make sure you do…
[2] Medicare.gov · When can I sign up for Medicare? · Medicaid answer · checked 2026-11-06
Most people with Medicaid don’t pay a premium for Part A. In most cases, your state will pay your monthly Part B premiums while you have Medicaid.
[3] Medicare.gov · When can I buy Medigap? · Medicaid answer · checked 2026-11-06
Insurance companies generally can’t sell you a Medigap policy if you have Medicaid coverage, even if you have both Medicare & Medicaid.
[4] Medicare.gov · Medicare & You 2027 (official handbook PDF) · page 73 · checked 2026-11-06
Dual Eligible SNP (D-SNP): You’re eligible for both Medicare and Medicaid. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits.

How we found this

We matched your question to 4 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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