Starting Medicare does not always mean losing Medicaid.

If you already have Medicaid when Medicare starts

You may qualify for both programs—often called dual eligibility. Medicare generally pays first for Medicare-covered services, and Medicaid can help with eligible remaining costs and other services under state rules. Medicaid eligibility may be reviewed under different age or disability categories; staying eligible is not automatic.

Contact your state Medicaid office before your Medicare start date. Confirm Parts A and B, premium assistance, prescription coverage, your providers, and any Medicaid managed-care coordination. Do not cancel existing benefits without understanding effective dates and what replaces them.

Medicare Savings Programs: help beyond prescriptions

• QMB (Qualified Medicare Beneficiary): helps eligible people pay Part A and B premiums and Medicare-covered deductibles, coinsurance, and copayments. Providers cannot bill QMB beneficiaries for Medicare-covered cost sharing, even if they do not accept Medicaid.
• SLMB and QI: help eligible people with the Part B premium. These are not the same as full Medicaid or comprehensive supplemental coverage.
• QDWI: can help certain working people with disabilities pay Part A premiums.

Income and resource rules vary by program and state; some states use more generous rules. Apply rather than assuming you earn too much. Ask your state Medicaid agency about the current limits and required documents.

LIS / Extra Help: assistance with Part D

The Low-Income Subsidy, usually called Extra Help, assists eligible people with Medicare prescription drug costs, including premiums, deductibles, and copayments within program limits. It is not Medigap and does not itself pay your Part B premium or all medical bills.

People with full Medicaid, a Medicare Savings Program, or Supplemental Security Income generally qualify automatically. Others may apply through Social Security at any time. Keep notices showing your eligibility, and check that your drug plan has applied the correct subsidy. A plan above the subsidy’s premium allowance can still leave a premium to pay.

Apply for Extra Help through Social Security ↗ · Medicare Savings Programs ↗

Special Enrollment Periods for Medicaid or Extra Help

Under current rules, people with Medicaid or Extra Help can generally use a monthly SEP to join or switch a stand-alone Part D plan, including returning from Medicare Advantage to Original Medicare with a stand-alone drug plan. A change generally takes effect the first day of the following month. Check eligibility and effects on all existing coverage before switching.

This does not provide unlimited monthly switching between all Medicare Advantage plans. A separate integrated-care SEP may let people with full Medicaid join or switch an eligible integrated D-SNP aligned with their Medicaid managed-care plan. Eligible plans, Medicaid status, service area, and alignment requirements matter.

Loss of Medicaid or Extra Help can create different, time-limited private-plan enrollment rights. Losing Medicaid can also create a separate Part A/B SEP if you delayed Medicare: it generally begins when you are notified and ends six months after Medicaid ends. Contact Social Security and Medicare promptly about the applicable window and start date, including any available retroactive coverage and premiums.

Bring the notices, not just the plan card.

A helpful review includes your Medicare effective dates, Medicaid and Extra Help notices, medication list, doctors, and any letter about losing coverage. Do not post those documents publicly or submit them through LI4W’s brief questionnaire.

Medicare: check your specific SEP ↗ · Official help-paying-costs guide ↗

Sources: Medicare & You 2026 and 2027, sections 1, 4, 6 and 7. Reviewed October 16, 2026. State eligibility and individual circumstances control. LI4W is not a government agency.