Two ways to have both
- Full NC Medicaid plus Medicare. Medicaid pays after Medicare and covers things Medicare doesn't, such as long-term nursing home care and CAP/DA services at home. For people 65 and older, NC's full Medicaid group (MAABD-N) has an income limit of 100% of the federal poverty level, plus a resource limit (MA-2252, effective April 1, 2026). If your income is higher, the medically needy program can help after you meet a monthly deductible.
- A Medicare Savings Program only. North Carolina calls these MQB: MQB-Q (QMB) up to 100% of poverty, MQB-B (SLMB) from 100% to 120% and MQB-E (QI) from 120% to 135%. They pay Medicare premiums and, for MQB-Q, Medicare cost sharing.
Who pays first
Medicare is primary. Your doctor, hospital or pharmacy bills Medicare (or your Medicare plan) first, and then NC Medicaid for what's left that it covers. NC Medicaid says it plainly for nursing facilities: "If a person has both Medicare and Medicaid, Medicare is billed first."
How NC Medicaid delivers your benefits
Most NC Medicaid members are in managed care, but Standard Plans are for people who are blind or disabled "and do not get Medicare." People who get Medicaid and Medicare are in NC Medicaid Direct, with care management through Community Care of North Carolina and LME/MCOs for behavioral health, I/DD and TBI services. As of November 13, 2026, NC Medicaid has announced no date to move full dual eligibles into managed care.
Your Medicare choices with Medicaid
Having Medicaid doesn't limit you to one kind of Medicare. You can keep Original Medicare with a Part D plan, or join a Medicare Advantage plan, including a dual eligible special needs plan (D-SNP). Every North Carolina D-SNP for 2027 is coordination-only, so your Medicaid stays in NC Medicaid Direct either way. You can request a call from a licensed insurance agent to compare plans from the companies they work with.
How to apply
- Apply online or at DSS. Use ePASS, or contact your county Department of Social Services in person, by phone, by mail or by fax.
- Ask for every program you may qualify for. The same application covers full Medicaid and MQB.
- Get help finding your DSS. Call the NC Medicaid Contact Center at 1-888-245-0179 (TTY 711).
The full picture is in our guide to NC Medicaid and Medicare.
Related questions
Medicare vs. Medicaid in North Carolina
Who runs each, who qualifies, what each covers.
Are dual eligibles in NC Medicaid managed care?
Why most stay in NC Medicaid Direct.
What is a D-SNP in North Carolina?
Medicare Advantage plans for people with both.
Sources
- NC Medicaid — Medicaid Health Plans and Programs
- NCDHHS — MA-2252, Non-MAGI Medicaid income and reserve limits
- NC Medicaid — Nursing Facilities
- NC Medicaid — How To Apply for NC Medicaid
- eCFR — 42 CFR 423.773, Extra Help eligibility
- Medicare.gov — Medicaid
More questions in this guide
- Are people with Medicare and Medicaid in NC Medicaid managed care?
- 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?
- Medicare vs. Medicaid in North Carolina
- 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
Do I lose Medicare if I get NC Medicaid?
No. You keep Medicare, and it stays your main coverage. NC Medicaid pays after Medicare and can also pay your Medicare premiums and cost sharing.
Will I be put in a Medicaid health plan if I have Medicare?
Not for most services. NC Medicaid lists people who get Medicaid and Medicare under NC Medicaid Direct. Some people with serious behavioral health needs or I/DD have those services managed through an LME/MCO or Tailored Plan.
Do I get help with Part D drug costs?
Yes. Full NC Medicaid or a Medicare Savings Program makes you eligible for Extra Help automatically (42 CFR 423.773(c)), so you don't need to apply separately to Social Security.
Medicare in your North Carolina county
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