Dual Eligibility: Medicare and Medicaid

Medicare and Medicaid are two different government health coverage programs, and some people qualify for both. When someone has Medicare and full Medicaid coverage at the same time, they are considered “dually eligible.”

This can be especially helpful for people who have Medicare but have limited income and resources. Medicaid may help with Medicare premiums and other out-of-pocket costs, while also covering certain services that Medicare does not generally cover.

Understanding how the two programs work together can help you recognize whether

you may qualify and what kind of assistance may be available.

What Does Dual Eligibility Mean?

Medicare and Medicaid serve different purposes.

Medicare is a federal health insurance program primarily for people age 65 and older. Some people under 65 can also qualify because of certain disabilities or medical conditions.

Medicaid is a joint federal and state program that provides health coverage to people who meet their state's eligibility requirements. Income, resources, age, disability, household circumstances, and other factors can be part of the eligibility determination. Medicaid rules vary by state.

Someone who qualifies for both programs can use them together. Medicare generally pays first for Medicare-covered services. Medicaid then pays after Medicare and any other health insurance that has a responsibility to pay.

For example, someone could have:

• Medicare Part A for hospital coverage

• Medicare Part B for medical services

• Medicare Part D for prescription drugs

• Medicaid to help with certain Medicare costs and additional services

The exact benefits depend on the person's Medicaid eligibility and the rules of their state.

Who Can Qualify for Both?

There are two separate questions to consider:

Do you qualify for Medicare? and Do you qualify for Medicaid?

Medicare eligibility generally comes from age or certain disability-related circumstances.

Medicaid eligibility is based on state-specific requirements, which can include income and resource limits.

For people who already have Medicare, limited income and resources may make them eligible for Medicaid or a Medicare Savings Program.

Medicare Savings Programs are particularly important because they can help pay Medicare costs even when someone does not qualify for full Medicaid coverage.

Depending on the program, assistance can include Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.

For 2026, the federal guidelines for several Medicare Savings Programs include:

Program	2026 Monthly Income Limit for an Individual	What It Can Help With
QMB	$1,350	Part A and Part B premiums, deductibles, coinsurance, and copayments
SLMB	$1,616	Part B premium
QI	$1,816	Part B premium
QDWI	$5,405	Part A premium for certain working disabled individuals

The limits shown above are federal figures for most states and DC. States can use different rules, and some states have higher income or resource limits or count certain income and assets differently. Applying through your state is the best way to determine eligibility.

How Medicare and Medicaid Work Together

Having both programs can change how your healthcare bills are handled.

For Medicare-covered services, Medicare generally pays first. Medicaid may then help with remaining eligible costs depending on the type of Medicaid coverage you have.

For someone with full-benefit Medicaid, the state may pay the Medicare Part B premium and may also help with other Medicare cost-sharing. If the person has to pay a Part A premium, Medicaid may also help with that cost depending on eligibility.

Medicaid can also cover services that Medicare generally does not cover. Depending on the state and the person's eligibility, these can include certain long-term care services, nursing facility care, personal care services, eyeglasses, hearing aids, and other benefits.

Prescription coverage has its own rules. People with full Medicaid coverage who also have Medicare generally receive their prescription drug coverage through Medicare Part D. They also automatically qualify for Extra Help with Medicare prescription drug costs.

This coordination is one of the reasons it is important to tell healthcare providers and pharmacies about both types of coverage.

What About Medicare Advantage?

Someone who is dually eligible can generally choose between Original Medicare and Medicare Advantage, although the available choices depend on the person's circumstances and location.

There are also Medicare Advantage plans specifically designed for people who qualify for both Medicare and Medicaid. These are called Dual Eligible Special Needs Plans, or D-SNPs.

D-SNPs are designed to coordinate Medicare and Medicaid benefits. Some plans may include additional benefits or services, and the plans available vary by location and Medicaid eligibility.

Someone with Medicaid or Extra Help also has additional opportunities to change Medicare drug coverage during the year. For example, people with Medicaid or Extra Help can generally make a Part D plan change once per calendar month, with the change taking effect the following month.

If you are considering a Medicare Advantage plan, check whether the plan works with your particular Medicaid coverage and whether your doctors, medications, and preferred services are included.

What Should You Do If You Think You May Qualify?

If you have Medicare and your income or resources are limited, it is worth checking whether you qualify for Medicaid or a Medicare Savings Program.

Start by gathering information about:

• Monthly income

• Social Security or pension income

• Bank accounts and other countable resources

• Medicare coverage

• Medicare premiums

• Household or marital status

• Medical expenses

• Other health insurance

• Prescription costs

Then contact your state Medicaid office to ask about Medicaid and Medicare Savings Programs. Your state makes the eligibility determination, and the application process varies by state.

You can also contact Medicare at 1-800-MEDICARE (1-800-633-4227) for information about Medicare coverage and programs that may help with Medicare costs.

Keep copies of your application, supporting documents, notices, and approval letters. If your income, resources, household, or other circumstances change, report the change according to your state's requirements because it can affect your eligibility.

Final Thoughts

Being eligible for both Medicare and Medicaid can provide an important layer of financial and healthcare support. Medicare serves as the primary health coverage for Medicare-covered services, while Medicaid may help with Medicare costs and provide additional benefits depending on your eligibility and state.

If you already have Medicare and are having difficulty keeping up with premiums, deductibles, copayments, prescription costs, or other healthcare expenses, checking your Medicaid and Medicare Savings Program eligibility can be a worthwhile step.

---

Up Next: Medicaid eligibility can look different for older adults than it does for other groups, particularly when income, resources, long-term care, and other financial considerations come into play.

In the next article, we'll walk through How to Apply for Medicaid as a Senior, including what information you may need, where to apply, and what to expect during the application process.

---

Pardon our ads, they allow us to keep our site running and keep our helpful content free to access.