Side by side
| Medicare | NC Medicaid | |
|---|---|---|
| Run by | CMS (federal); you sign up through Social Security | NCDHHS, Division of Health Benefits; county DSS offices decide eligibility |
| Who qualifies | 65 and older; under 65 with SSDI for 24 months, ALS or end-stage renal disease | Based on income, resources, age, disability and other rules |
| Income test | None to qualify (higher incomes pay IRMAA) | Yes; full Medicaid for people 65 and older is at 100% of the federal poverty level (MA-2252) |
| Long-term care | Short skilled nursing stays only | Nursing home care, CAP/DA at home, PACE |
| How you get care | Original Medicare or a Medicare Advantage plan | NC Medicaid Direct or a NC Medicaid Managed Care health plan |
| Where to apply | Social Security | ePASS or your county DSS |
When you have both
North Carolinians with both programs are called dual eligibles. Medicare pays first. NC Medicaid then pays what it covers, and it can pay your Medicare premiums and cost sharing. People with both get Extra Help with Part D automatically (42 CFR 423.773(c)). Unlike most Medicaid members, people with Medicare and Medicaid are in NC Medicaid Direct rather than a Standard Plan; NC Medicaid's Standard Plans are for people who are blind or disabled "and do not get Medicare."
If your income is too high for full Medicaid, a Medicare Savings Program may still pay your Part B premium. North Carolina calls these programs MQB: MQB-Q, MQB-B and MQB-E, up to 135% of the federal poverty level. See Medicare Savings Programs in North Carolina.
What Medicaid expansion changed
Since December 1, 2023, NC Medicaid covers adults 19 through 64 with income up to 138% of the federal poverty line. That group is for people who aren't entitled to or enrolled in Medicare (42 CFR 435.119), so expansion mostly helps people before Medicare starts, such as a spouse under 65.
What to do next
- Sign up for Medicare on time. Your initial enrollment period runs seven months around your 65th birthday month. See enrollment periods.
- Check whether you qualify for NC Medicaid or MQB. Apply through ePASS or your county DSS; the NC Medicaid Contact Center (1-888-245-0179) can help you find it.
- Review your Medicare coverage. With both programs, you can stay with Original Medicare and a Part D plan or choose a Medicare Advantage plan. You can request a call from a licensed insurance agent to compare plans from the companies they work with.
More in our guide to NC Medicaid and Medicare.
Related questions
Can I have NC Medicaid and Medicare at the same time?
How dual eligibility works.
Did NC Medicaid expansion help people on Medicare?
Who the 2023 expansion reaches.
Does NC Medicaid pay for nursing home care?
Where Medicare stops and Medicaid starts.
Sources
- Medicare.gov — Parts of Medicare
- Medicare.gov — Medicaid
- NC Medicaid — Medicaid Health Plans and Programs
- NCDHHS — MA-2252, Non-MAGI Medicaid income and reserve limits
- NC Medicaid — North Carolina Expands Medicaid
- eCFR — 42 CFR 435.119, adult expansion group
- NC Medicaid — How To Apply for NC Medicaid
More questions in this guide
- Are people with Medicare and Medicaid in NC Medicaid managed care?
- Can I have NC Medicaid and Medicare at the same time?
- Did NC Medicaid expansion change anything for people on Medicare?
- Does NC Medicaid pay for nursing home care?
- Does NC Medicaid take your house after you die?
- What is a dual eligible special needs plan in North Carolina?
- What is Special Assistance in North Carolina?
- What is the CAP/DA waiver in North Carolina?
- What is the Medicaid look-back period in North Carolina?
Part of the guide: NC Medicaid and Medicare together · All questions
Frequently asked questions
Is NC Medicaid the same as Medicare?
No. Medicare is a federal program run by CMS that you earn through work history or disability. NC Medicaid is a joint federal-state program run by NCDHHS that you qualify for based on income, resources and other rules, and your county Department of Social Services decides eligibility.
Which one pays for a nursing home?
Medicare covers only short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. NC Medicaid can pay for long-term nursing home care if you meet its financial and medical rules.
Where do I apply for each?
Apply for Medicare through Social Security (1-800-772-1213, TTY 1-800-325-0778) or ssa.gov. Apply for NC Medicaid online through ePASS or through your county Department of Social Services.
Medicare in your North Carolina county
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