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Navigating Medicaid for Seniors
Once you turn 65, you are evaluated under Medicaid for seniors, which uses stricter criteria.
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NAPCA - Mon, 26, May 2025
- 16:42 EDT
- 17
Representative image / NAPCA
When people turn 65, many face a shift in their health insurance coverage. Some may feel unsettled or frustrated to find out that their Medicaid coverage ends. In this month’s column, we will explain why this happens and what options may still be available.
<Q1> Why did I lose Medicaid after enrolling in Medicare at 65, even though my income hasn’t changed?
When you turn 65 and enroll in Medicare, your eligibility for Medicaid may change—even if your income stays the same. This is due to how Medicaid rules differ for people under and over the age of 65.
If you were previously covered under Expanded Medicaid—available in states that cover low-income adults under 65 earning up to 138% of the federal poverty level (FPL)—you may lose eligibility once you turn 65. In 2025, that limit is a monthly income of $1,800 for an individual or $2,432.25 for a couple.
Once you turn 65, you are evaluated under Medicaid for seniors, which uses stricter criteria. In addition to income, this program considers your assets (e.g., savings accounts, retirement funds). So even if your income hasn’t changed, having too much in assets can disqualify you from Medicaid.
It’s also important to note that Medicaid eligibility rules and limits for seniors vary by state and are updated annually.
<Q2> Can I keep my Medicaid after enrolling in Medicare at age 65?
Yes—if you meet your state’s income and asset limits for seniors, you can still receive Medicaid alongside Medicare, making you a “dual eligible.”
If you receive Supplemental Security Income (SSI), you generally qualify for full Medicaid benefits. In 2025, the federal SSI limit is:
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Individual: Monthly income under $967 and assets under $2,000
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Couple: Monthly income under $1,450 and assets under $3,000
Some states offer State Supplementary Payments (SSP) or have higher income limits. For example:
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California: A couple may qualify with income up to $2,432.25/month, and California does not count assets.
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Washington State: Limits match federal SSI—$1,450/month income and less than $3,000 in assets for a couple.
If you qualify, Medicaid can help pay for:
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Medicare Part A and B premiums
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Deductibles and co-pays
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Additional services not covered by Medicare, such as dental, vision, and long-term care
You may also qualify for Extra Help, a program that lowers prescription drug costs under Medicare Part D. In many states, enrollment in Extra Help is automatic if you have Medicaid for seniors, but some states require a separate application.
<Q3> If I no longer qualify for full Medicaid coverage with Medicare, what other programs or assistance might be available to me?
If you're not eligible for full Medicaid, you may still qualify for the Medicare Savings Program (MSP). This program helps pay for:
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Medicare Part B premiums
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Part A premiums (if applicable)
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Sometimes other out-of-pocket costs
Enrollment in MSPs also makes you automatically eligible for Extra Help with Part D costs.
There are three types of MSPs, based on income level, and eligibility varies by state. Even if you don’t qualify for an MSP, you may still be eligible for Extra Help on its own.
In 2025, you may qualify for Extra Help if:
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Individual: Monthly income up to $1,956 and assets under $17,600
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Couple: Monthly income up to $2,643 and assets under $35,130
To find out what programs you’re eligible for, contact your state Medicaid office or call our Helpline for assistance.
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