Can You Have Medicaid and Private Insurance? Exploring Your Coverage Options

Pinterest LinkedIn Tumblr

Are you wondering if it’s possible to have both Medicaid and private health insurance at the same time? The answer is yes! In fact, having dual coverage can be financially beneficial for those who meet certain income requirements.

Can You Have Medicaid and Private Insurance? Exploring Your Coverage Options

Is Dual Coverage Right For You?

Dual coverage refers to individuals who qualify for both Medicaid and are also eligible for employer-sponsored or privately purchased insurance plans. It’s important to consider personal circumstances when deciding if dual coverage is right for you.

Benefits of Dual Coverage

There are several benefits of having dual coverage, including:

  • Broader range of care options: With two health insurance policies, you may be able to access a wider network of healthcare providers.
  • Reduced out-of-pocket costs: Both private insurance plans and Medicaid often require co-payments, but with dual coverage, one policy may cover expenses not covered by the other.
  • Improved financial protection: If one policy doesn’t cover a specific medical expense, the secondary policy may provide additional support.

Eligibility Requirements

To be eligible for both types of insurance at once:

  1. Income: To qualify for Medicaid, your annual gross income must fall below a certain level based on your household size. If your current household income exceeds this amount but still meets federal poverty guidelines, you may be able to obtain subsidized private insurance through
  2. Insurance Plans: Your eligibility will depend on whether your employer offers an affordable health plan that meets minimum value standards set by the Affordable Care Act (ACA).

Coordination Of Benefits

When you have two different health policies covering the same service or treatment need; coordination between them is crucial because it determines which insurer pays first – primary vs second payer – ensuring any remaining payment obligations come from the other plan.

Primary And Secondary Payers Rule

– Primary Payer – “The Health Plan that pays benefits first” for services and treatments.
– Secondary Payer – “The Health Plan that pays next, after the primary plan.

This is done to optimize savings by reducing out-of-pocket costs; so, be sure to coordinate coverage
and understand how it will work before obtaining dual health insurance.


Dual coverage can offer significant financial advantages and a wider range of healthcare options but deciding on which plans make sense for you or coordinating payment between two separate payers can also be confusing tasks. So understanding your health insurance policies is necessary before choosing this option or making claims from both Medicaid and private insurers in order to avoid facing negative consequences such as denials or even losing benefits altogether.


Q: Can I have both Medicaid and private health insurance?
A: Yes, you can be enrolled in both Medicaid and a private health insurance plan at the same time. This is called having “dual coverage.” Dual coverage may help cover additional healthcare costs that your primary plan does not cover.

Q: If I have dual coverage, which insurance pays first?
A: It depends on your situation. Your primary insurance will usually pay for covered services first. After that, your secondary (Medicaid) coverage may act as a backup to cover any remaining costs after your primary insurer has paid its share.

Q: If I qualify for both Medicaid and private health insurance, do I need to enroll in both?
A: No, you don’t necessarily need to enroll in both programs. If you have access to affordable private health insurance through an employer or otherwise, then it may make sense to stick with only private coverage. However, if you’re insured by Medicare or are experiencing financial hardship, then enrolling in Medicaid could provide additional benefits and cost savings for certain medical expenses. It’s important to weigh the pros and cons of each option before making a decision.