Medicare and Medicaid together: dual eligibility

What does dual eligible mean?

Being dual eligible means you qualify for both Medicare (federal health insurance, usually for people 65+) and Medicaid (state-administered insurance for people with limited income). When you have both, the two programs work together to cover more of your healthcare costs than either one alone.

Medicare pays first as the primary insurer for hospital stays, doctor visits, and other covered services. Medicaid pays second, picking up costs that Medicare doesn't fully cover — like deductibles, coinsurance, and copays. Medicaid may also cover services Medicare doesn't, like long-term nursing home care and personal care assistance.

Full vs. partial dual eligibility

Full dual eligibility

You receive both Medicare and comprehensive Medicaid benefits. Medicaid covers your Medicare premiums, cost-sharing, and additional services like long-term care, dental, vision, and transportation. You automatically qualify for Extra Help with Part D drug costs.

Partial dual eligibility (Medicare Savings Programs)

You receive help from a Medicare Savings Program (MSP) that covers some Medicare costs, but not full Medicaid benefits. There are four MSPs:

• QMB (Qualified Medicare Beneficiary) — Pays Part A and Part B premiums, deductibles, coinsurance, and copays. Income limit: $1,350/month for individuals in 2026
• SLMB (Specified Low-Income Medicare Beneficiary) — Pays Part B premiums only. Income limit: $1,615/month
• QI (Qualifying Individual) — Pays Part B premiums only. Income limit: $1,815/month
• QDWI (Qualified Disabled and Working Individual) — Pays Part A premiums for certain disabled working individuals

Enrolling in any MSP automatically qualifies you for Extra Help with Part D costs.

Benefits of dual eligibility

• Lower drug costs — Extra Help can save you an estimated $5,700 per year on prescriptions
• No Part D late penalty — you won't be penalized for gaps in drug coverage
• Monthly plan changes — you can switch Part D or Medicare Advantage plans once per month (most people can only switch during open enrollment)
• Additional coverage — Medicaid may cover dental, vision, hearing, transportation, and long-term care that Medicare doesn't
• D-SNP option — special Medicare Advantage plans designed for dual-eligible people that coordinate both programs under one plan

How to become dual eligible

You need to be enrolled in both programs separately:

1. Enroll in Medicare through Social Security (most people are automatically enrolled at 65)
2. Apply for Medicaid through your state's Medicaid office — eligibility rules vary by state

Your state's SHIP counselor can help you apply for Medicaid and Medicare Savings Programs at no cost.