Can I have Medicare and Medicaid at the same time in Ohio?

Yes — and many Ohioans do. These are called 'dual-eligibles.' To qualify for both, you'd be Medicare-eligible (65+ or disabled) AND meet Ohio Medicaid's income/asset limits. About 20% of Medicare beneficiaries also have Medicaid. In Ohio, full duals can enroll in Next Generation MyCare Ohio for integrated coverage.

Does Medicare or Medicaid pay first for someone with both?

Medicare is primary — it pays first for services it covers. Medicaid is secondary — it pays Medicare deductibles, copays, and coinsurance for covered services, AND pays for services Medicare doesn't cover (like dental, vision, long-term care). For dual-eligibles, this combination produces very low out-of-pocket costs.

If I'm on Medicaid now and I turn 65, do I automatically get Medicare?

Not automatically — you have to enroll in Medicare. But if you're already receiving Social Security, you'll be auto-enrolled in Medicare Parts A and B at 65. If you're not on Social Security, apply for Medicare during your Initial Enrollment Period (3 months before your 65th birthday). Your Medicaid coverage typically continues if you still meet eligibility, transitioning you to dual-eligible status.

How do I apply for Medicaid in Ohio?

Apply online at benefits.ohio.gov — the fastest path. Your county Job & Family Services office processes the application. Required information: Social Security numbers, proof of income, proof of resources (bank accounts, vehicles, etc. for some categories), proof of identity and Ohio residency. OSHIIP counselors and Area Agencies on Aging can help with the application.

Will my Medicare Advantage plan still work if I get Medicaid?

Maybe — depends on the plan and your dual-eligible status. If you become a full dual-eligible, you may want to switch to a D-SNP (Dual-Eligible Special Needs Plan) or Next Generation MyCare Ohio for better coordination. Dual-eligibility triggers a Special Enrollment Period to make changes. Some MA plans accept duals but don't coordinate well with Medicaid — D-SNPs are designed specifically for duals.

If my spouse qualifies for Medicaid LTC, can I keep our home?

Generally yes. Under Ohio's spousal impoverishment rules, the community spouse (non-applicant) can keep the family home plus a substantial portion of countable resources ($154,140 in 2026). The applicant spouse's Medicaid eligibility considers only the applicant's share of assets. After both spouses die, Medicaid Estate Recovery may seek reimbursement from the estate, including the home — but spousal impoverishment protects the community spouse during their lifetime. Elder law attorneys help families plan this transition.

Medicare vs Medicaid in Ohio: What's the Difference? (2026)

On this page

The fundamental difference
How Medicare works in Ohio
How Medicaid works in Ohio
Dual-eligibles: Medicare AND Medicaid
Medicare Savings Programs (partial Medicaid)
Long-term care: Medicaid's biggest role
Common questions

The fundamental difference

The most common confusion in American healthcare: these two programs sound similar but serve different purposes.

	Medicare	Medicaid
Who runs it	Federal (CMS)	Joint federal-state (Ohio Department of Medicaid)
Who's eligible	65+, disabled (24 months SSDI), ESRD, ALS	Low-income people of any age meeting categorical requirements
Eligibility basis	Age or disability — NOT income	Income and (for some categories) assets
Funding	Payroll taxes + premiums + general revenue	State and federal tax revenue (federal matches state spending)
Premiums	Part A free for most; Part B $202.90/mo (2026)	Free for most enrollees; small copays for some services
Geographic scope	Nationwide	State-specific (rules differ by state)
Long-term nursing home	Not covered (except short-term skilled care)	Covered indefinitely for qualified beneficiaries

The two programs aren't competitors — they cover different populations and different needs. About 20% of Medicare beneficiaries also have Medicaid (dual-eligibles).

How Medicare works in Ohio

Medicare in Ohio works the same as Medicare anywhere — it's a federal program. Key features for Ohioans:

Part A (hospital insurance) — free for most enrollees; covers inpatient hospital, SNF, hospice, some home health.
Part B (medical insurance) — $202.90/month standard 2026 premium; covers doctor visits, outpatient, DME.
Part C (Medicare Advantage) — private alternative bundling A, B, often D plus extras.
Part D (drug coverage) — outpatient prescriptions; $2,100 annual OOP cap in 2026.

Ohio Medicare beneficiaries can pair Original Medicare with a Medigap policy for cost-sharing protection, or choose Medicare Advantage. Both work statewide.

How Medicaid works in Ohio

Ohio Medicaid covers more than 3 million Ohioans (about 1 in 4 state residents). Major eligibility categories:

Adults under 65 below 138% FPL — Ohio expanded Medicaid under the ACA, covering childless adults.
Children — up to 200% FPL through Medicaid; CHIP (Healthy Start) extends to 211% FPL.
Pregnant women — up to 200% FPL.
Aged, Blind, and Disabled (ABD) — Medicaid for 65+ or disabled with income below state thresholds.
Long-Term Care Medicaid — for nursing home or HCBS waiver eligibility.

Most Ohio Medicaid enrollees are in managed care plans — Aetna Better Health, AmeriHealth Caritas Ohio, Anthem Blue Cross Blue Shield, Buckeye Health Plan, CareSource, Humana Healthy Horizons in Ohio, Molina Healthcare, and UnitedHealthcare Community Plan. Medicaid covers comprehensive medical care, dental, vision, mental health, substance abuse treatment, and long-term services.

Dual-eligibles: Medicare AND Medicaid

About 20% of Ohio Medicare beneficiaries also qualify for Medicaid — "dual-eligibles." For duals, the programs coordinate:

Medicare is primary for medical services covered by both programs.
Medicaid is secondary for services Medicare covers but with cost-sharing — Medicaid often picks up Medicare deductibles, copays, and coinsurance.
Medicaid covers services Medicare doesn't — dental, vision, hearing aids, transportation, long-term care, and other benefits.
Extra Help (LIS) is automatic for duals — Part D premiums and copays are dramatically reduced or eliminated.

In Ohio, dual-eligibles can enroll in Next Generation MyCare Ohio — an integrated plan combining Medicare, Medicaid, and HCBS waiver services. MyCare launched January 1, 2026 in 29 counties and is rolling out statewide through August 2026 with four MCOs (Anthem, Buckeye, CareSource, Molina). See our MyCare Ohio guide.

Ohio Medicare beneficiary who might also qualify for Medicaid?A licensed Ohio Medicare agent or OSHIIP counselor (1-800-686-1578) can help you apply for Medicaid, Medicare Savings Programs, or Extra Help and coordinate the two programs. No cost to you.

Find a Medicare Agent in Ohio

Medicare Savings Programs (partial Medicaid)

Even if you don't qualify for full Medicaid, you may qualify for Medicare Savings Programs (MSPs) — state-administered programs that help pay Medicare costs:

Program	What it pays	Approx. 2026 income limit (single)
QMB (Qualified Medicare Beneficiary)	Part A & B premiums, deductibles, coinsurance, copays	$1,304/month
SLMB (Specified Low-Income Medicare Beneficiary)	Part B premium	$1,562/month
QI (Qualifying Individual)	Part B premium	$1,756/month

Asset limits apply: $9,660 single / $14,470 couple for QMB/SLMB/QI in 2026. Apply through your Ohio county Job & Family Services. Most MSP recipients also automatically qualify for Extra Help (Part D Low-Income Subsidy).

Long-term care: Medicaid's biggest role

The single largest gap in Medicare is long-term care coverage. Medicare doesn't cover:

Long-term nursing home stays
Assisted living
Memory care
In-home personal care attendants (beyond limited home health)

For these services, Ohio Medicaid Long-Term Care is the primary payer for those who qualify (after meeting income and asset limits, typically requiring asset spend-down). Ohio also operates HCBS waivers like PASSPORT (for seniors 60+) and the Assisted Living Waiver.

See our Does Medicare cover nursing home care? page for the full long-term care picture.