How Medicaid Works Alongside SSDI and Medicare

When you receive SSDI and turn 65, Medicare becomes your primary health insurance. But Medicare does not cover everything—dental work, vision care, hearing aids, and long-term nursing home care all have gaps. Medicaid can fill those gaps, paying for services Medicare does not, and it costs nothing if you meet the income and resource limits.

The amount of income you can have and still get Medicaid varies by state. Some states use the federal SSDI payment amount as the limit (roughly $1,415 per month in 2024, though this changes yearly). Other states allow higher income. A few states have removed the income limit altogether for people on SSDI. Because the rules differ so much, you need to check with your state Medicaid office to know whether you may have access to.

Medicaid is not automatic when you get SSDI. You have to request it, usually through your state's Medicaid agency or social services department. The process is separate from your SSDI process, even though both are government programs.

Key Takeaways

  • Medicaid covers services Medicare does not pay for, including dental, vision, hearing aids, and long-term care in nursing homes.
  • Income limits for Medicaid vary by state—some follow the federal SSDI amount, others allow more, and a few have no limit for SSDI recipients.
  • You must request Medicaid separately from your state Medicaid office; it does not come automatically with SSDI.
  • Resource limits (savings, property, and other assets) also vary by state and can affect whether you get Medicaid.
  • If your SSDI payment is very low, you may still may have access to for Medicaid in your state even if you have other income.

What Medicaid Covers That Medicare Does Not

Medicare covers hospital stays, doctor visits, and some outpatient care. It does not cover routine dental cleanings, eyeglasses, hearing aids, or most long-term care in a nursing home or assisted living facility. Medicaid fills many of these gaps.

In most states, Medicaid pays for dental work (though the scope varies—some states cover only emergency care, others cover cleanings and fillings). Medicaid also covers vision care, including eye exams and glasses. Hearing aids are covered in some states but not others. If you need to move to a nursing home and your savings run out, Medicaid can pay for your care there, which Medicare will not do.

Medicaid also covers some prescription drugs that Medicare's drug plan does not, and it usually has lower copays and deductibles than Medicare. If you are on a very tight budget, Medicaid can mean the difference between getting care and going without.

Income and Resource Limits by State

Medicaid looks at two things: your monthly income and your total resources (savings, property, investments). Both matter, and both vary by state.

For income, some states use the federal benefit rate—the base SSDI payment amount set by Social Security each year. In 2024, that is roughly $1,415 per month for an individual, but it changes annually. If your SSDI payment is below that amount, you automatically meet the income test in those states. If your SSDI payment is higher, you do not may have access to in those states.

Other states use a higher income limit, sometimes 200% or 300% of the federal benefit rate. A few states have removed the income limit for people receiving SSDI, meaning you can have any amount of monthly income and still may have access to if you meet the resource test.

For resources, most states allow you to own up to $2,000 in countable assets (savings, stocks, bonds). Some states allow more. Your home and one vehicle usually do not count. Money in a dedicated ABLE account (a tax-advantaged savings account for people with disabilities) does not count either. Again, your state sets the exact limit.

Because these rules change and vary so widely, the only way to know whether you may have access to in your state is to contact your state Medicaid office directly. You can find it through your state's health department website or by calling 211.

How to Request Medicaid When You Are on SSDI

Medicaid is not automatic. You have to request it through your state's Medicaid agency, which may be called the Department of Social Services, Department of Health and Human Services, or something similar depending on your state.

You can usually request Medicaid online through your state's website, by mail, in person at a local office, or by phone. You will need to provide proof of your SSDI award (a copy of your Social Security award letter), proof of income (your SSDI payment stub), and proof of resources (bank statements, investment statements). Some states also ask for proof of citizenship or residency.

Processing time varies. Some states decide within two weeks; others take a month or more. If you are denied, you have the right to request a hearing and present your case to a state official. Many people win on appeal, so do not give up if you are turned down the first time.

What Happens to Medicaid If Your SSDI Payment Changes

If your SSDI payment increases—because of a cost-of-living adjustment, a work incentive, or a change in your case—your Medicaid may be affected. In states that use the federal benefit rate as the limit, a higher SSDI payment could make you ineligible. In states with higher income limits or no income limit, an increase usually will not matter.

If your SSDI payment decreases, Medicaid will not automatically increase. You may need to report the change to your state Medicaid office, depending on your state's rules.

The safest approach is to tell your state Medicaid office about any change in your SSDI payment and ask how it affects your coverage. Do not assume you have lost Medicaid or that you still have it—confirm with the office.

Medicaid and Nursing Home Care

One of the biggest gaps Medicare leaves is long-term care in a nursing home. Medicare covers up to 100 days of skilled nursing care after a hospital stay, but only if you meet strict conditions. After that, you pay out of pocket—nursing home care costs $100,000 to $150,000 per year on average, though costs vary widely by location.

Medicaid covers nursing home care for people who cannot pay, but only after your savings are nearly gone. Most states require you to spend down your assets to $2,000 or less before Medicaid will pay. Your home is usually protected (Medicaid will not force you to sell it), and a small amount of monthly income is set aside for personal needs. The rest goes to the nursing home.

This is one reason some people on SSDI plan ahead and set up trusts or ABLE accounts—to protect assets while still getting Medicaid coverage when they need it. If you think you may need nursing home care someday, talk to an elder law attorney or your state Medicaid office about your options.

Frequently Asked Questions

If I get Medicaid, do I have to pay back the government?

No. Medicaid is not a loan. You do not have to repay the cost of services Medicaid covers. However, if you receive Medicaid and later inherit money or win a lawsuit settlement, some states can try to recover costs from your estate after you die. This is rare and usually applies only to people over 55 who received long-term care.

Can I have both Medicare and Medicaid at the same time?

Yes. People on SSDI who turn 65 get Medicare automatically. If you also meet your state's Medicaid income and resource limits, you can have both. Medicaid is called the "secondary payer," meaning Medicare pays first, and Medicaid covers what Medicare does not.

What if my state does not cover dental or vision care through Medicaid?

Some states cover dental and vision only for children or pregnant women, not for adults on SSDI. If your state does not cover these services, you may be able to find low-cost dental and vision clinics through community health centers or dental schools. Call 211 to find clinics near you.

Does my SSDI payment count as income for Medicaid?

Yes. Your SSDI payment is counted as unearned income. Other income you have (from work, pensions, or family support) also counts. Some states exclude a small amount of income, but most count your full SSDI payment toward the income limit.

What if I live in a state with no Medicaid expansion?

All states have Medicaid for people on SSDI, but the income limits and covered services vary. If your state has a low income limit and you do not may have access to, you may want to look into Medicare Savings Programs, which help pay your Medicare premiums and cost-sharing. You can learn about these through your state Medicaid office or by calling 1-800-MEDICARE.