Having Medicare and Medicaid Together in New York

What each program does in a dual household

The two rows that change lives are the long-term care ones. A household that understands only Medicare plans around a benefit that does not exist, and finds out at the worst possible moment. What long-term care actually costs and who pays.

The three levels of “both”

People say dual eligible for three different situations, and the differences matter.

Full dual eligibility. You have Medicare and full Medicaid. Medicaid covers cost sharing, fills benefit gaps and pays for long-term services. This is the strongest position.

Partial: QMB. Income at or below 138% of the federal poverty level. Medicaid pays Medicare premiums and the deductibles, coinsurance and copays. Providers may not bill you for that cost sharing on covered services. You do not get full Medicaid benefits such as long-term care.

Partial: QI. Income at or below 186% of the federal poverty level. Medicaid pays the Part B premium, which for most people means a larger Social Security payment arriving each month.

New York applies no asset test to QMB or QI. Full Medicaid for people 65 and older does apply resource rules. And from October 1, 2026, QMB and QI are open only to citizens, green card holders past or not subject to the five-year bar, Cuban and Haitian entrants and citizens of the Compact of Free Association nations; other non-citizens keep Medicaid with state funds but lose the savings program. The 2026–2027 immigration changes. The savings programs in detail.

How to get the Medicaid side

Where: the local department of social services, which in New York City is the Human Resources Administration. Not NY State of Health, which handles the under-65 income-based categories. Which door and what to bring.

What it looks at: income and resources, in the category for people 65 and older or applying on the basis of disability.

If income is over the limit: that is not the end. New York’s Excess Income program sets a monthly spend-down, and a pooled income trust redirects the excess to your rent and groceries while Medicaid disregards it. For anyone who needs home care, the trust is the standard route.

Ask for everything in one conversation: full Medicaid, a Medicare Savings Program, and Extra Help with prescriptions. They are separate determinations and asking for one does not trigger the others.

What changes about your Medicare

Very little, and that surprises people who expect to have to give something up.

You keep Original Medicare or your Medicare Advantage plan. Your doctors do not change because of dual eligibility itself. What changes is who pays the premium and the cost sharing, and what happens when you need care that Medicare does not cover.

New York does offer integrated plans designed for people with both programs, which coordinate the two under one card. Whether one fits depends on the same question as any plan choice: whether your doctors and your hospital are in it. How to check that in an hour.

From 2027, an insurer that also runs a Medicaid managed care plan in your area may offer only one plan of this kind for people with full Medicaid, and new enrollment in it is limited to members of its own Medicaid plan. Ask which Medicaid plan a dual plan is tied to before you join it.

Two cautions. Dual eligibility can create additional opportunities to change plans outside the usual window; confirm the current rule with a HIICAP counselor at 1-800-701-0501 rather than assuming either that you are locked in or that you can switch freely. And a Medicare supplement is the wrong product here: it is illegal to sell a Medigap policy to someone the seller knows has Medicaid, except in narrow situations, because Medicaid already fills those gaps.

What goes wrong

Only one of the two ever gets applied for. Usually Medicare, because it arrives with age, while Medicaid requires someone to act.

Providers bill QMB patients for cost sharing they may not charge. If you have QMB and receive a bill for a deductible or coinsurance on a Medicare-covered service, that is worth challenging in writing rather than paying.

The renewal is missed. The Medicaid side renews and the notice goes to the address on file. This is the leading cause of losing coverage that someone still qualifies for. How renewals fail.

Home care hours get cut at reassessment, and the deadline to keep them running while appealing is about ten days, much shorter than the sixty days to appeal at all. Fair hearings and aid continuing.