Medicaid and Medicare

NC Medicaid and Medicare together

You can have NC Medicaid and Medicare at the same time. Medicare pays first, and NC Medicaid pays after it for costs and services it covers, including long-term care. As of November 2026, people with both Medicare and full NC Medicaid get their Medicaid through NC Medicaid Direct, not a Standard Plan, and NC Medicaid has announced no date for moving them into managed care.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 13, 2026

Quick answers

Can I have NC Medicaid and Medicare at the same time?: Yes. People with both are called dual eligibles. Medicare pays first; NC Medicaid pays after Medicare for what it covers and can pay your Medicare premiums and cost sharing.
Am I in NC Medicaid Managed Care if I have Medicare?: Not for most services. NC Medicaid lists people who get Medicaid and Medicare under NC Medicaid Direct. State law (G.S. 108D-40) permanently keeps people with only Medicare Savings Program help out of the managed care health plans.
Did Medicaid expansion help people on Medicare?: Mostly not. Expansion, which began December 1, 2023, covers adults 19 through 64 who are not entitled to or enrolled in Medicare. People on Medicare qualify through North Carolina's aged, blind and disabled rules or a Medicare Savings Program instead.
What is CAP/DA?: NC Medicaid's home and community-based waiver for adults 18 and older who need a nursing-home level of care but want to live at home. Participants must be in NC Medicaid Direct, and since February 16, 2024, new applicants may be placed on a statewide waitlist.
How do I apply for NC Medicaid if I'm on Medicare?: Apply online through ePASS, or in person, by phone or by mail through your county Department of Social Services. The NC Medicaid Contact Center, 1-888-245-0179, can help you find your county DSS.

What does it mean to have both?

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

Full-benefit dual eligibles have full NC Medicaid. Medicaid pays after Medicare and also covers care Medicare doesn't, such as long-term nursing home care and CAP/DA services at home.
Partial-benefit dual eligibles get only a Medicare Savings Program, which North Carolina calls MQB (MQB-Q, MQB-B or MQB-E). It pays Medicare premiums and, for MQB-Q, Medicare cost sharing. See Medicare Savings Programs in North Carolina.

Either way, you keep Medicare and it pays first. You also get Extra Help with Part D drug costs automatically (42 CFR 423.773(c)). About 2,328,318 North Carolinians had Medicare in July 2026 (CMS).

Who qualifies for NC Medicaid with Medicare?

People with Medicare qualify through North Carolina's aged, blind and disabled Medicaid rules, which count both income and resources. NC Medicaid's chart MA-2252 (effective April 1, 2026) sets the income limit for full Medicaid for people 65 and older (MAABD-N) at 100% of the federal poverty level, the same line as MQB-Q. If your income is higher, two routes remain:

Medically needy (MAABD-M): Medicaid starts paying once your medical bills reach your monthly deductible (spend-down), which the county DSS figures from your income.
Medicare Savings Programs: MQB-B (100% to 120% of poverty) and MQB-E (120% to 135%) pay the Part B premium.

Your home is generally not counted while you live in it, while your spouse or a dependent relative lives there, or while you intend to return (MA-2230).

Medicaid expansion and Medicare

On December 1, 2023, NC Medicaid expanded to adults ages 19 through 64 with income up to 138% of the federal poverty line. Federal law limits that group to people who are not entitled to or enrolled in Medicare Part A or Part B (42 CFR 435.119), so expansion mostly doesn't reach people on Medicare. It can matter for a spouse under 65 or for someone with a disability who is still waiting for Medicare to start. Starting January 1, 2027, expansion adults must meet a work or community engagement rule unless exempt; people with a disability are among the exemptions. More: Did expansion help people on Medicare?

NC Medicaid Direct, managed care and the EBCI Tribal Option

Most NC Medicaid members get care through a NC Medicaid Managed Care health plan. People with Medicare are different:

Program	Who it serves	People with Medicare?
Standard Plans	Most families, children, pregnant women, and people who are blind or disabled and do not get Medicare	No
Behavioral Health and I/DD Tailored Plans	People with serious mental illness, severe substance use disorders, I/DD or TBI, and Innovations and TBI waiver members	Some people with both have behavioral health or I/DD services managed this way
EBCI Tribal Option	Federally recognized tribal members and others eligible for Indian Health Service care in 11 western counties	Not confirmed: ask NC Medicaid
NC Medicaid Direct	People not in managed care, including "people who get Medicaid and Medicare," CAP/DA and PACE participants and the medically needy	Yes, today's home for most dual eligibles

NC Medicaid Direct includes care management for physical health through Community Care of North Carolina, and local management entity/managed care organizations (LME/MCOs) coordinate mental health, substance use, I/DD and TBI services. State law, G.S. 108D-40(a)(1), permanently keeps people with only Medicare Savings Program help out of the health plans. Full dual eligibles are excluded "for a period of time to be determined by the Department" (G.S. 108D-40(a)(13)). As of November 13, 2026, NC Medicaid has announced no date to move them. More: Are dual eligibles in NC Medicaid managed care?

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. Each D-SNP must have a contract with the state Medicaid agency (42 CFR 422.107). In CMS's 2027 plan data, every D-SNP in North Carolina is "coordination-only": the plan coordinates with NC Medicaid, but your Medicaid benefits still come from NC Medicaid Direct. North Carolina has no fully or highly integrated D-SNPs for 2027, so PACE is the main way to get Medicare and Medicaid from one organization. See D-SNPs in North Carolina and D-SNP vs. Original Medicare and NC Medicaid.

Long-term care: nursing homes, CAP/DA, PACE and Special Assistance

Medicare covers only short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. It doesn't pay for long-term custodial care. NC Medicaid and NCDHHS programs can:

Option	Who it's for	Source
Nursing facility care	People who meet Medicaid's financial rules (county DSS) and medical rules (an NC Medicaid review team)	NC Medicaid; MA-2270
CAP/DA waiver	Disabled adults 18 and older who meet a nursing-facility level of care and need at least one CAP/DA service at home	NC Medicaid CAP/DA page
PACE	Age 55 and older, nursing-home level of care, living in a PACE area, able to live safely at home	NC Medicaid PACE page; 42 CFR Part 460
State/County Special Assistance	People 65 and older, or 18 to 64 and disabled, with low income who live in an adult care home or need that level of care at home	G.S. 108A-41; NCDHHS

North Carolina has no income cap for nursing home Medicaid, so no qualified income trust is needed. Your income goes toward your care each month, and Medicaid can pay the rest if your income is less than the nursing home's private rate plus your medical bills (MA-2270). See Does NC Medicaid pay for nursing home care?, the CAP/DA guide and Special Assistance.

When you ask Medicaid to pay for nursing home care, CAP/DA or PACE, the county looks back 60 months at gifts and transfers for less than market value (MA-2240). An improper transfer leads to a sanction period when Medicaid won't pay for that care. See the look-back period.

Estate recovery

After death, NC Medicaid files a claim against the estate of a member who was 55 or older, for nursing facility services, home and community-based services, hospital care, prescription drugs and personal care services, or against the estate of a member of any age who lived in a medical institution and was not expected to return home (G.S. 108A-70.5). The claim reaches only property in the estate and can't exceed what Medicaid paid for those services. Recovery is deferred while a spouse is living or while there is a surviving child under 21 or a blind or disabled child, and NC Medicaid waives small estates and small claims and offers an undue hardship waiver to heirs. Help from a Medicare Savings Program alone isn't recovered (42 U.S.C. 1396p(b)(1)(B)(ii)). More: Does NC Medicaid take your house after death?

How to apply

Make sure you have Medicare. If you have never signed up for Part A or Part B, contact Social Security (1-800-772-1213, TTY 1-800-325-0778).
Apply for Medicaid. Apply online through ePASS (you'll need an NCID; Medicaid is called "Medical Assistance" on the application) or through your county Department of Social Services in person, by phone, by mail or by fax. The same application covers MQB.
Ask about long-term care if you need it. Tell DSS if you need nursing home care, CAP/DA or PACE. For CAP/DA, a referral also goes to NCLIFTSS (919-568-1717 or 833-522-5429) or a local CAP/DA case management entity.
Apply soon if you have recent medical bills. Medicaid can cover care from up to 3 months before you apply if you apply by December 31, 2026; from January 1, 2027, that drops to 2 months for adults 65 and older and people with a disability.
Answer every letter and renewal. Missing a DSS deadline is a common reason people lose Medicaid they still qualify for.
Review your Medicare choices. With Medicaid, you can stay with Original Medicare and a Part D plan, or look at D-SNPs and other Medicare Advantage plans.

Where to get help

NC Medicaid Contact Center: 1-888-245-0179 (Mon–Fri 8 a.m.–5 p.m.; TTY through RelayNC, 711).
Your county Department of Social Services for applications, renewals and Special Assistance.
NCDHHS Customer Service Center: 1-800-662-7030.
NC Division of Aging and the 16 area agencies on aging, and the regional long-term care ombudsman offices for nursing home and adult care home problems.
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: North Carolina Medicare contacts.

Sources

Every question in this guide

Frequently asked questions

How do I apply for NC Medicaid if I'm on Medicare?

Apply online through ePASS or through your county Department of Social Services (DSS), in person, by phone, by mail or by fax. On the application, Medicaid is called Medical Assistance. If you need nursing home care, CAP/DA or PACE, say so, so the county also applies the long-term care rules.

What is PACE in North Carolina?

PACE (Program of All-Inclusive Care for the Elderly) covers Medicare and Medicaid care through one local team for people 55 and older who need a nursing-home level of care, live in a PACE service area and can live safely at home. NC Medicaid says 11 PACE organizations operate in 14 locations in the state.

What is a Medicaid deductible in North Carolina?

If your income is too high for full Medicaid, North Carolina's medically needy program can still help once your medical bills reach a set amount, called a deductible or spend-down. The county DSS figures your deductible from your income. People who qualify this way stay in NC Medicaid Direct.

Does Medicaid replace Medicare when I have both?

No. You keep Medicare, and it pays first. NC Medicaid pays after Medicare and covers some care Medicare doesn't, such as long-term nursing home care and CAP/DA services at home.

Do I get Extra Help automatically with NC 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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