For millions of older Americans, Medicare is the go-to health insurance option after age 65. But what many don’t realize—until they need it—is that Medicare doesn’t cover everything. In fact, some of the most critical (and expensive) health-related needs for seniors—like long-term care—fall outside Medicare’s limits.
That’s where Medicaid comes in.
Medicaid is often viewed as a safety-net program for low-income families, but it also plays a crucial role in supporting older adults who have limited financial resources or need ongoing care that Medicare won’t cover. When seniors are “dual eligible” for both Medicare and Medicaid, they gain access to a broader set of benefits that can ease financial stress, improve care coordination, and fill essential gaps.
Whether you’re a caregiver, a senior managing your own coverage, or simply preparing for the future, understanding what Medicaid offers beyond Medicare can help you make smarter decisions about care and cost. Here’s what you need to know.
Medicare: Strong Foundation, But Clear Limits
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It’s excellent for covering many acute and outpatient services, such as:
Doctor visits
Hospital stays
Surgery
Skilled nursing (for limited durations)
Preventive screenings
Some home health care
However, there are gaps in what Medicare covers. Key services it does not fully address include:
Long-term custodial care in nursing homes or assisted living
Routine dental, vision, and hearing care
Extended home health support for daily living
Prescription drug coverage (unless Part D is added)
Help with premiums, copays, and coinsurance for low-income beneficiaries
This is where Medicaid becomes especially important for seniors—particularly those with chronic conditions, disabilities, or very limited income.
Medicaid: Filling the Gaps for Seniors Who Qualify
Medicaid is a state and federally funded program that provides health coverage to eligible low-income individuals, including seniors. Each state runs its own Medicaid program with different rules, but all states offer core benefits that are particularly relevant for seniors, such as:
Long-Term Care Services
One of the biggest gaps Medicaid fills is long-term care. While Medicare may pay for short-term stays in a skilled nursing facility after hospitalization, it does not cover custodial care—the kind of care needed when someone requires help with bathing, dressing, eating, or other daily activities.
Medicaid, on the other hand, is the primary payer for long-term care in the U.S., covering both nursing home stays and, in many states, Home and Community-Based Services (HCBS) that help seniors stay in their homes longer.
This includes:
Personal care aides
Adult day health programs
Home-delivered meals
Home health aides
Supportive housing services
These supports can make an enormous difference for seniors with mobility issues, cognitive decline, or chronic illness—and for families trying to avoid institutional care.
Help Paying for Medicare Costs
For seniors with limited income, Medicaid can also cover Medicare premiums, deductibles, and coinsurance. This is often done through the Medicare Savings Program (MSP), which has different tiers based on income level.
Depending on eligibility, Medicaid may:
Pay the Medicare Part B premium (saving seniors over $2,000 per year)
Cover copays for doctor visits, hospital stays, or outpatient care
Eliminate or reduce prescription drug costs under Medicare Part D
This dual coverage helps reduce out-of-pocket expenses and makes it easier for low-income seniors to access care without skipping treatments or prescriptions due to cost.
Prescription Drug Support
While Medicare Part D provides drug coverage, it can still leave seniors with monthly premiums, deductibles, and medication tiers that require cost-sharing.
Seniors who qualify for Medicaid often also qualify for the Extra Help program, which significantly reduces costs under Part D—including:
Lower monthly premiums
Waived deductibles
Reduced copays on both generic and brand-name drugs
This coordination between Medicaid and Medicare ensures that drug costs stay predictable and affordable for those with limited means.
Dental, Vision, and Hearing Benefits (In Some States)
Original Medicare does not cover routine dental care, eye exams for glasses, or hearing aids—despite these being essential for quality of life. Many Medicaid programs offer some form of coverage for these services, though benefits vary widely by state.
Some examples of Medicaid-covered benefits in certain states include:
Annual cleanings, fillings, or extractions
Eyeglasses and vision exams
Hearing exams and coverage for hearing aids
Even in states with limited coverage, Medicaid may cover these services under special programs for dual-eligible seniors or those with specific conditions.
Who Qualifies for Medicaid as a Senior?
Eligibility for Medicaid is based on income and assets, and the thresholds vary by state. For seniors, many states use Supplemental Security Income (SSI) standards or offer higher limits through state-specific programs.
In general, a senior may qualify if they:
Are 65 or older
Have income below a certain threshold (varies by state and household size)
Have limited countable assets (often under $2,000 for individuals, not including a home, car, or burial plots)
Need help with long-term care services or meet medical need requirements
Some states also use a “spend-down” process, allowing seniors with slightly higher incomes to qualify by deducting medical expenses.
It’s important to note that many seniors are eligible for dual coverage—meaning they qualify for both Medicare and Medicaid. This offers the most comprehensive set of benefits and cost protections.
How to Apply for Medicaid as a Senior
Seniors can apply for Medicaid through:
Their state’s Medicaid agency or website
A local Medicaid office or social services agency
A trained benefits counselor, elder law attorney, or healthcare navigator
Because Medicaid is state-administered, the process and required documentation will differ depending on where you live. In general, you’ll need to provide:
Proof of age and citizenship/legal residency
Income statements (Social Security, pensions, etc.)
Bank account and asset information
Medical documentation if applying for long-term care support
Applying early—and getting help from someone familiar with the process—can prevent delays and ensure you get the full benefits you’re entitled to.
Why Medicaid Is a Critical Lifeline for Low-Income Seniors
While Medicare provides a vital foundation of healthcare access for older Americans, it was never designed to cover everything. Medicaid fills in the essential pieces: long-term care, affordability assistance, and access to non-Medicare services.
As people live longer, with more complex health needs, Medicaid is becoming increasingly important not just for the lowest-income seniors, but also for middle-income retirees who outlive their savings or need prolonged care.
For families navigating the costs of aging, understanding Medicaid’s role—and planning ahead—is one of the smartest ways to protect a loved one’s health, dignity, and financial security.
Final Thought
If you’re a senior—or caring for one—Medicaid can be more than a fallback option. It can be a powerful support system that picks up where Medicare leaves off. From paying for nursing home care to covering the cost of eyeglasses or prescription drugs, Medicaid offers essential services that can make aging more affordable and less stressful.
The key is to understand what’s available in your state, know how the programs coordinate, and take action before a crisis hits. Because when Medicare and Medicaid work together, the result isn’t just coverage—it’s care that actually meets real-life needs.
