Medicaid and Medicare

Florida Medicaid and Medicare together

You can have Florida Medicaid and Medicare at the same time. Medicare pays first, and Florida Medicaid pays after it for what it covers. Most people with Medicare and low income get a Medicare Savings Program; full Medicaid usually comes through SSI, Medically Needy or long-term-care Medicaid, because Florida's MEDS-AD group excludes most people on Medicare.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 14, 2026

Quick answers

Can I have Florida Medicaid and Medicare at the same time?: Yes. People with both are called dual eligibles. Medicare pays first; Florida Medicaid pays after Medicare for what it covers and can pay your Medicare premiums and cost sharing.
Can I get MEDS-AD if I have Medicare?: Usually not. DCF's rules require a MEDS-AD applicant to not be receiving Medicare, unless they also get nursing home, hospice or home and community-based care (including PACE).
Do I have to join a Medicaid plan if I have Medicare?: If you have full Medicaid, usually yes: Florida law puts most Medicaid recipients in Statewide Medicaid Managed Care (SMMC), and having Medicare doesn't exempt you. People with only a Medicare Savings Program don't join an SMMC plan.
Did Florida expand Medicaid?: No. Florida is one of 10 states that have not adopted the Medicaid expansion (KFF, November 2026). Expansion wouldn't cover people on Medicare anyway.
How do I apply for Florida Medicaid if I'm on Medicare?: Apply through ACCESS Florida, run by the Department of Children and Families (DCF): online at MyACCESS or by phone at (850) 300-4323. One application covers Medicaid and the Medicare Savings Programs.

What does it mean to have both?

People who have Medicare and Florida Medicaid are called dual eligibles. There are two kinds:

Full-benefit dual eligibles have full Florida Medicaid. Medicaid pays after Medicare and also covers care Medicare doesn't, such as long-term nursing home care and, through the Long-Term Care program, care at home or in an assisted living facility.
Partial-benefit dual eligibles get only a Medicare Savings Program: QMB, SLMB or QI-1. These pay Medicare premiums and, for QMB, Medicare deductibles and coinsurance. See Medicare Savings Programs in Florida.

Either way, you keep Medicare and it pays first, and you get Extra Help with Part D drug costs automatically (42 CFR 423.773(c)). 5,344,538 Floridians had Medicare in July 2026 (CMS).

Who qualifies for full Medicaid with Medicare?

Florida's rules for people who are aged, blind or disabled are in DCF's Economic Self-Sufficiency (ESS) policy manual. The key Florida fact: the MEDS-AD group (aged and disabled people with income up to 88% of the federal poverty level) requires that you not be receiving Medicare, unless you also receive nursing home, hospice or home and community-based services, which includes PACE (ESS 2040.0813.03). So a Floridian on Medicare who lives at home usually gets full Medicaid only through one of these routes:

Route	Who it fits
SSI	People who get Supplemental Security Income. Social Security decides SSI, and SSI recipients are eligible for Medicaid.
Medically Needy (share of cost)	People whose income is too high for other groups. Medicaid pays in a month once your medical bills reach your share of cost.
Institutional Care Program (ICP)	People who need Medicaid to pay for a nursing home. See Florida Medicaid long-term care.
Long-Term Care (home and community) or PACE	People who meet a nursing-home level of care and are enrolled in these programs; MEDS-AD then becomes possible.

Many people with Medicare and modest income qualify instead for a Medicare Savings Program, which has higher income limits (about 100%, 120% and 135% of the federal poverty level). More: What is MEDS-AD?

Medicaid expansion: Florida has not expanded Medicaid (KFF, data as of November 6, 2026). Expansion covers adults under 65 who aren't on Medicare, so it wouldn't change these rules for people with Medicare.

Statewide Medicaid Managed Care (SMMC)

AHCA, Florida's Medicaid agency, runs Statewide Medicaid Managed Care. It has three parts: Managed Medical Assistance (MMA) for medical care, Long-Term Care (LTC), and dental. The current version, SMMC 3.0, began February 1, 2025, with nine regions (A to I).

Full duals join an MMA plan. Florida law says all Medicaid recipients receive services through managed care (s. 409.965), and the exemption for people with other coverage excludes Medicare (s. 409.972(1)(a)). AHCA's MMA contract says the plan can't make a full dual eligible choose a new primary care doctor or stop seeing their Medicare primary care doctor.
Medicare stays separate. Your MMA plan is your Medicaid plan; Medicare still pays first, through Original Medicare or a Medicare plan you choose.
Choosing or changing. AHCA's choice counselors (1-877-711-3662) help you pick an SMMC plan. After you enroll, you can change plans during the first 120 days, then during your yearly open enrollment or for a state-approved good cause.
MSP only: QMB-only Medicaid is limited to paying Medicare premiums, deductibles and coinsurance (ESS 2040.0817), so there's no SMMC plan to choose.

More: Do I have to join a Medicaid plan if I have Medicare?

Medically Needy (share of cost)

If your income is over the limits for other groups, Medically Needy can still help. DCF compares your countable income with the Medically Needy income level; the difference is your monthly share of cost, which you meet with your own medical bills. Once your bills reach it, Medicaid can pay for covered care for the rest of that month (Fla. Admin. Code 65A-1.713). It's figured month by month. Medically Needy can't be used to qualify for home and community-based long-term care (ESS 2040.0815.01). DCF's current income and asset standards are in Appendix A-9.

Medicare Advantage plans for dual eligibles

A dual eligible special needs plan (D-SNP) is a Medicare Advantage plan only for people with Medicare and Medicaid. Florida has many: CMS's 2027 data show 127 D-SNPs from 14 parent companies, sold in all 67 counties. Florida's contracts with them set three levels:

FIDE SNPs (3 plans for 2027, in 42 counties) cover Medicare and Medicaid, including Medicaid long-term care, through one company.
HIDE SNPs (60 plans) cover Medicare plus some Medicaid benefits under a contract with AHCA.
Coordination-only D-SNPs (64 plans) can enroll only people with partial Medicaid help (QMB, SLMB, QI or QDWI), not full Medicaid.

See D-SNPs in Florida and D-SNP vs. Original Medicare and Florida Medicaid.

Long-term care, PACE and estate recovery

Medicare covers only short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period, not long-term custodial care. Florida Medicaid covers it through the SMMC Long-Term Care program (nursing homes, assisted living and care at home) and PACE. Home and community-based care has a priority-based wait list; nursing home care has an income cap, with a Qualified Income Trust for people over it; and gifts in the 60 months before applying are reviewed. Florida recovers Medicaid paid after age 55 from a person's estate, with exceptions for a surviving spouse and certain children (s. 409.9101). Details: Florida Medicaid long-term care.

How to apply

Make sure you have Medicare. If you haven't signed up for Part A or Part B, contact Social Security (1-800-772-1213, TTY 1-800-325-0778).
Apply through ACCESS Florida. DCF decides Medicaid for people who are aged or disabled and not on SSI. Apply online at MyACCESS or call DCF's customer call center at (850) 300-4323 (Florida Relay 711, TTY 1-800-955-8771). Florida uses one application for all its assistance programs, including the Medicare Savings Programs.
Say if you need long-term care. Nursing home Medicaid, home and community-based care and PACE also need a medical review of your level of care by the state's CARES program.
Answer every DCF letter and renewal. Missing a deadline is a common reason people lose Medicaid they still qualify for. See How to renew Medicaid on ACCESS Florida.
Review your Medicare choices. With Medicaid you can keep Original Medicare with a Part D plan, or look at D-SNPs and other Medicare Advantage plans.

Where to get help

DCF customer call center (Medicaid and Medicare Savings Program applications): (850) 300-4323.
AHCA Medicaid Helpline (problems with Medicaid plans or services): 1-877-254-1055, TDD 1-866-467-4970.
SMMC choice counseling (pick or change a Medicaid plan): 1-877-711-3662.
1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) or Medicare.gov.
To review Medicare plan options from the companies they work with, you can request a call from a licensed insurance agent.

More numbers: Florida Medicare contacts.

Sources

Every question in this guide

Frequently asked questions

How do I apply for Florida Medicaid if I'm 65 or older?

Apply online through MyACCESS (ACCESS Florida, run by DCF) or call DCF's customer call center at (850) 300-4323 (Florida Relay 711). If you get SSI, Social Security handles your Medicaid. One application covers full Medicaid and the Medicare Savings Programs.

What is Medically Needy (share of cost) Medicaid in Florida?

If your income is too high for full Medicaid, Medically Needy can pay medical bills in a month once your own bills reach your share of cost, the amount your countable income is over the Medically Needy income level. DCF figures it month by month.

What is Medicaid choice counseling in Florida?

Choice counseling is AHCA's help line for picking or changing a Statewide Medicaid Managed Care (SMMC) plan: 1-877-711-3662. It helps with Medicaid plans, not Medicare plans.

Does my Medicaid from another state transfer to Florida?

No. Medicaid is run by each state. When you move to Florida, apply for Florida Medicaid or a Medicare Savings Program through ACCESS Florida, and close your old state's case.

Do I get Extra Help automatically with Florida Medicaid?

Yes. Under 42 CFR 423.773(c), people with full Medicaid or a Medicare Savings Program are treated as eligible for Extra Help with Part D costs without a separate application to Social Security.

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