Birthday celebrations are a big deal, especially those milestone birthdays. It’s just as important to celebrate 65 as it is to celebrate 18. Both are significant years that usher in a lot of changes. When you turn 65, it’s time to revisit your health insurance options – you can now enroll in Medicare. But what if you already have Medicaid (called Medical Assistance in Minnesota)? Here’s what you need to know, including next steps and reviewing insurance options.

Will you lose Medicaid if you get Medicare?

Once you turn 65 (or under 65 for people with specific disabilities), you will become eligible for Medicare. This means it’s time to choose a Medicare plan! But does qualifying for Medicare mean you’ll lose your Medicaid coverage? Not necessarily.

You can benefit from having both programs at once, known as being dual eligible. To qualify, you must be eligible for both Medicare Parts A and B and your state’s Medicaid program individually. Each has different eligibility criteria that can include age, income level, disability status and more.

Do you need Medicare if you have Medicaid?

If you’re currently enrolled in Medicaid, it’s still a good idea to get Medicare coverage when you become eligible – this will help you avoid Medicare penalties associated with late enrollment.

And although you can have both together, Medicaid and Medicare are separate programs that cover different health care services. This includes things like medical and hospital care, dental care, long-term care and more. If you’re enrolled in both, you have access to a larger array of health care services.

Medicaid will also help you pay some of the costs associated with Medicare – like premiums, deductibles and cost-sharing elements like copays and coinsurance. These Medicaid benefits for seniors can significantly reduce out-of-pocket expenses, meaning you won’t have to worry about a Medicare supplement plan.

But what about prescriptions? If you’re dual eligible, you can get additional help paying for Medicare Part D prescription drug coverage through Medicaid or Extra Help.

Next steps for getting Medicaid coverage at age 65

When turning 65, it’s critical to review your options months in advance. A dual-eligible special needs plan is a great choice for those with limited income who need more coverage.

To get started, you’ll want to contact your state’s Medicaid office. But remember, Medicaid eligibility is different from state to state. In Minnesota, your local county will determine your eligibility for Medical Assistance based on your situation.

Sign up for Medicare

Since you can have Medical Assistance and Medicare at the same time, it’s a good idea to sign up for Medicare as soon as you’re eligible. If you’re getting Social Security benefits, the Social Security Administration (SSA) will automatically sign you up for Medicare Parts A and B. If you aren’t getting Social Security, you’ll need to apply for Medicare through the SSA.

Need a refresher on Social Security and Medicare? Learn how Medicare and Social Security are different – and how they can work together.

Transitioning from Medicaid to Medicare at 65 – or to one plan that combines both programs

Once you turn 65, you become eligible for Medicare coverage. However, during this time, your eligibility for Medicaid can also change. But why is this? Under the Affordable Care Act (ACA), most state Medicaid programs expanded health coverage for Americans under the age of 65. If you once qualified for Medicaid as part of this specific Medicaid expansion group, you may no longer be eligible once you hit your 65th birthday. However, that’s not the case for everyone.

Many seniors assume that once they turn 65, it’s time to switch from Medicaid coverage to Medicare. However, there’s no need if you are dual eligible – you can access the benefits of both Medicaid and Medicare at the same time.

If you meet a certain income requirement, your eligibility for Medicaid can be re-evaluated before your 65th birthday to see if you qualify for another Medicaid eligibility group. If you continue to be eligible for Medicaid once you turn 65 and also qualify for Medicare, you’ll be considered dual eligible for both Medicare and Medicaid.

Being dual eligible can help those who qualify access a wide range of affordable services. Medicaid may offer coverage for services that Medicare doesn’t, such as assisted living and other types of long-term nursing facility care, prescription drugs, eye care, vision care, home- and community-based services and more. But what happens if you aren’t eligible for Medicaid and still need that extra help? Some seniors may qualify for their state’s Medicare Savings Program. These programs can help those on Medicare pay premiums or out-of-pocket costs.

Review Medicare and Medicaid options in your county

Different health plans are available based on where you live. If you live in Minnesota and already have Medical Assistance, you’ve most likely been in touch with a county worker who has helped you with your plan. As you approach your 65th birthday, you will automatically be enrolled in a Medical Assistance plan for seniors.

Your options at age 65 as a Minnesota resident include the Medicaid-only plan called Minnesota Senior Care Plus (MSC+) or the Medicare and Medicaid plan called Minnesota Senior Health Options (MSHO).

  • Determine if you are dual eligible for Medicare and Medicaid. If you are, MSHO combines the services of both programs and may be a good choice for you. With MSHO, you don’t need to worry about coordinating coverage between both programs and can have it all in one.
  • Understand what’s covered in each plan type
  • Compare MSHO vs. MSC+ plans to decide which plan is best for you

Work with a long-term care social worker

If you are in a nursing home or assisted living, the facility’s social worker can help you and your family complete the steps to get the right plan. The social worker is a helpful resource and can help you access the programs for which you qualify.

Get more info on Medicaid eligibility after age 65

If you think you’re eligible for an MSC+ or MSHO plan, you can get information from: