Fair Square Medicare Wordmark

Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

A person with a shopping cart already containing medicaid and medicare sees Medigap options on a table. In a thought bubble, they ask "Should I get Medigap too?"

By Daniel Petkevich

Jan 7, 2023

You may enroll in more than one plan, but you don't need all three. Here's why:

Medicare, Medicaid, and Medigap (also known as Medicare Supplement) often overlap; sometimes, people sign up for more than one plan. But is there ever a time when you should enroll in all three?

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

We want you to get the best benefits possible, so we'll walk you through everything you need to know.

Let's explore Medicare, Medicaid, and Medigap in more detail, get a sense of their differences, and discuss whether to enroll in more than one plan.

What's the Difference Between Medicare, Medicaid and Medigap?

Medicare, Medicaid and Medigap all assist in covering your healthcare expenses. But they help different populations and meet unique needs.

Let's take a look at each plan.

Medicare

Medicare

is a health insurance program administered by the U.S. federal government.

It provides coverage to people ages 65+ and those with disabilities or

ESRD

(end-stage renal disease).

There are four parts to Medicare:

  • Part A — part of Original Medicare; covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare

  • Part B — part of Original Medicare; covers medically necessary services and preventive care, such as doctor visits, lab tests, and durable medical equipment

  • Part C (Medicare Advantage) — alternative to Parts A and B offered by private insurance companies; combines all the benefits of Parts A and B and often includes additional benefits, such as prescription drug coverage

  • Part D — prescription drug benefit that can be added to Original Medicare (Parts A and B) or a Part C plan

Medicaid

Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families — including the elderly, individuals with disabilities, children, and pregnant women.

Medicaid might cover a wide range of medical services, such as:

  • Doctor visits

  • Hospital stays

  • Prescription drugs

  • Long-term care

  • Immunizations

  • Screenings

Medicaid is administered by the states (rather than at a federal level). And each state has its own eligibility criteria and benefits. To be eligible for Medicaid, you must meet your state's income and asset requirements.

Medigap

Medigap is a supplemental insurance policy that supplements Original Medicare (Part A and Part B).

It helps cover certain out-of-pocket costs — like copayments, coinsurance, and deductibles. However, it doesn't cover

long-term care

, vision, dental, hearing aids, private-duty nursing, and prescription drugs.

Medigap policies are offered by private insurance companies and are standardized by the federal government. You can choose from

10 Medigap plans

depending on your requirements.

Medicare Supplement Plan G

offers the most comprehensive coverage for many of our clients.

Can I Get Both Medicare and Medicaid Benefits Together?

Yes. You can benefit from Medicare and Medicaid if you're dually eligible. In other words, you have to meet the eligibility requirements for both Medicare and Medicaid.

To be dually eligible, you must meet the following conditions:

  • Be 65 years or older or have a disability (like ESRD)

  • Have a low income

How Do Medicare and Medicaid Work Together?

Medicare covers 80% of your healthcare expenses, while Medicaid helps cover the remaining out-of-pocket costs left by Medicare Parts A and B.

In other words, Medicare covers services that Medicaid doesn't and vice versa.

For example, Medicare may cover your hospital stays, doctor visits, and lab tests, while Medicaid covers your additional expenses like premiums, prescription drugs, eyeglasses,

hearing aids

and long-term care. Both work together to maximize your benefits and provide comprehensive coverage.

To better understand how these two programs work together, you need to be familiar with two terms: coordination of benefits and crossover claims.

What Is Coordination of Benefits?

When a person has multiple health insurance plans (like Medicare and Medicaid), providers must coordinate their benefits to avoid overpaying or duplicating coverage. Coordination of benefits determines which health insurance plan should pay for a medical service or claim first.

  • "Primary" payer — the insurance plan that pays first

  • "Secondary" payer — the plan that pays second

In general, Medicare is the primary payer, and Medicaid is the secondary payer. This means Medicare will pay for covered medical services first, and Medicaid will pay for any remaining expenses not covered by Medicare — like copayments, deductibles and coinsurance.

What's a Crossover Claim?

A crossover claim is a medical claim submitted to multiple insurance plans. They're used when an individual has two insurance plans that coordinate their benefits.

For example, if you’re enrolled in both Medicare and Medicaid, your provider will submit the claim to Medicare. Medicare will process the claim first and apply any deductibles, coinsurance, or copayments. The claim will then be automatically forwarded to Medicaid. (Note: Your provider doesn't have to bill Medicaid separately for the deductible, coinsurance, or copayments that Medicare applied).

Is Medigap Necessary If You Are Eligible for Both Medicare and Medicaid?

No. You don't need to enroll in a Medigap Plan if you're enrolled in Medicare and are eligible for full Medicaid benefits.

Here's why:

  • Most of your medical expenses are likely covered if you're dually eligible for Medicare and Medicaid

  • Insurance companies aren't permitted to sell Medigap policies to Medicare beneficiaries with full Medicaid coverage

I Don't Qualify for Medicaid. Can I Still Get a Medigap Plan?

Yes! Medigap plans are good for individuals who don't qualify for Medicaid. They're especially helpful if you have a high income or assets and need help with out-of-pocket costs not covered by Original Medicare (Parts A and B).

Takeaway

Medicare, Medicaid, and Medigap are all health insurance programs that cover your medical expenses. Medicaid is specifically designed to help low-income individuals pay for out-of-pocket costs. In contrast, Medigap plans often help high-income individuals — who aren't eligible for Medicaid — pay for their out-of-pocket costs.

You don't need to enroll in a Medigap Plan if you're eligible for both Medicare and Medicaid. Medicaid will likely cover most of your out-of-pocket expenses.

Having multiple health insurance plans can give you more comprehensive coverage. But it can also be confusing. At

Fair Square Medicare

, we have helped thousands of beneficiaries understand the ins and outs of Medicare and make informed decisions about their coverage. If you have any questions, give us a call at 1-888-376-2028.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

Recommended Articles

stack of books stock image

Do You Need Books on Medicare?

Apr 6, 2023

heart surgery stock image

How Much Does Open Heart Surgery Cost with Medicare?

Jan 27, 2023

Birthday stock image

What Is the Medicare Birthday Rule in Nevada?

Mar 28, 2023

Cover image

Does Medicare Have Limitations on Hospital Stays?

Mar 15, 2024

Cover image

When to Choose Medicare Advantage over Medicare Supplement

Jun 7, 2023

Cover image

How Are Medicare Star Ratings Determined?

Sep 6, 2023

Philadelphia skyline at sunset stock image

13 Best Ways for Seniors to Stay Active in Philadelphia

Mar 7, 2023

Fair Square

Do I Need to Renew My Medicare?

Nov 29, 2022

Pre-Existing condition stock image

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Mar 28, 2023

Fair Square

Building the Future of Senior Healthcare

Aug 25, 2022

Senior couple going over their finances stock photo

Explaining IRMAA on Medicare

Dec 21, 2022

Cover image

Does Medicare cover Hyoscyamine?

Nov 30, 2022

Closeup of a male Doctor or physiotherapist doing stretching for a patient in the clinic for examining treating injured of back stock photo

Does Medicare Cover Chiropractic Visits?

Dec 22, 2022

Caucasian nurse holding spine model against the patients backs. Clinic interior. stock photo

Does Medicare Cover SI Joint Fusion?

Nov 28, 2022

Cover image

Will Medicare Cover it?

Oct 3, 2023

Cover image

Medicare Advantage MSA Plans

May 17, 2023

Cover image

How Much Does a Medicare Coach Cost?

Mar 20, 2023

Sleep apena stock image

Does Medicare Cover Inspire for Sleep Apnea?

Dec 27, 2022

More of our articles

13 Best Ways for Seniors to Stay Active in Columbus

14 Best Ways for Seniors to Stay Active in Nashville

14 Best Ways for Seniors to Stay Active in Seattle

14 Best Ways to Stay Active in Charlotte

2024 Fair Square Client Retention and Satisfaction Report

2025 Medicare Price Changes

Are Medicare Advantage Plans Bad?

Can Doctors Choose Not to Accept Medicare?

Can I Change Medicare Advantage Plans Any Time? | Medicare Plans

Can I switch From Medicare Advantage to Medigap?

Can Medicare Advantage Plans be Used Out of State?

Can Medicare Help with the Cost of Tyrvaya?

Comparing All Medigap Plans | Chart Updated for 2025

Denied Coverage? What to Do When Your Carrier Says No

Do I Need Medicare If My Spouse Has Insurance?

Does Medicare Cover Boniva?

Does Medicare Cover Breast Implant Removal?

Does Medicare Cover Cervical Disc Replacement?

Does Medicare Cover Cold Laser Therapy (CLT)?

Does Medicare Cover Diabetic Eye Exams?

Does Medicare Cover Disposable Underwear?

Does Medicare Cover Driving Evaluations?

Does Medicare Cover Exercise Physiology?

Does Medicare Cover Flu Shots?

Does Medicare Cover Fosamax?

Does Medicare Cover Jakafi?

Does Medicare Cover Kidney Stone Removal?

Does Medicare Cover Linx Surgery?

Does Medicare Cover Lipoma Removal?

Does Medicare Cover Nuedexta?

Does Medicare Cover Ofev?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Oxybutynin?

Does Medicare Cover Penile Implant Surgery?

Does Medicare Cover Piqray?

Does Medicare Cover Scleral Lenses?

Does Medicare Cover Stair Lifts?

Does Medicare Cover TENS Units?

Does Medicare Cover Vitamins?

Does Medicare Pay for Antivenom?

Does Medicare Pay for Varicose Vein Treatment?

Does Retiring at Age 62 Make Me Eligible for Medicare?

Does Your Plan Include A Free Gym Membership?

Explaining the Different Enrollment Periods for Medicare

Fair Square Client Newsletter: AEP Edition

Finding the Best Dental Plans for Seniors

How Does Medicare Cover Colonoscopies?

How Much Does a Pacemaker Cost with Medicare?

How Much Does Medicare Part B Cost in 2025?

How Much Does Trelegy Cost with Medicare?

How Much Does Xeljanz Cost with Medicare?

Is Balloon Sinuplasty Covered by Medicare?

Is Displacement Affecting Your Medicare Coverage?

Is Gainswave Covered by Medicare?

Is HIFU Covered by Medicare?

Is the Shingles Vaccine Covered by Medicare?

Medicare 101

Medicare Deductibles Resetting in 2025

Medicare Supplement Plans for Low-Income Seniors

Medigap Plan N vs. Plan G — Which One Fits You in 2025?

Moving? Here’s What Happens to Your Medicare Coverage

Top 10 Physical Therapy Clinics in San Diego

Welcome to Fair Square's First Newsletter

What If I Don't Like My Plan?

What Is a Medicare Advantage POS Plan?

What is Plan J?

What is the Medicare ICEP?

What You Need to Know About Creditable Coverage

What's the Difference Between HMO and PPO Plans?

When Can You Change Medicare Supplement Plans?

Why You Should Keep Your Medigap Plan

Will Medicare Cover Dental Implants?

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.

Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2025

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M

Fair Square Medicare

FSM symbol - 50