Dual Eligibility (Medicare + Medicaid)

When someone qualifies for both Medicare and Medicaid, they become "dually eligible." This pairing creates a powerful safety net, greatly reducing out-of-pocket expenses for healthcare and prescriptions.

Who Qualifies:

• Already enrolled in Medicare (due to age or disability)

• Meets state Medicaid income and asset guidelines

Types of Dual Eligible Status:

• Full dual eligible: Gets full Medicaid and Medicare benefits

• Partial dual eligible: Receives help with some Medicare costs (like premiums)

Key Benefits:

• Medicaid pays Medicare premiums, copays, and deductibles

• Automatic enrollment in the Extra Help program

• Access to Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs)

• Coordination of care between Medicaid and Medicare providers

How to Apply:

1. Apply for Medicaid through your state’s program

2. Notify Medicare of your eligibility so benefits can be coordinated

3. Ask your insurance or care provider if they accept QMB (Qualified Medicare Beneficiary) plans

Need help figuring out if you're dual eligible? Reach out to your local State Health Insurance Assistance Program (SHIP) for free guidance.

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