Dual Eligibility for Medicare and Medicaid: How It Works and What You Can Get

If you have a limited income and health care costs are overwhelming, dual eligibility—being enrolled in both Medicare and Medicaid—can dramatically lower what you pay for coverage and care.

What Does “Dual Eligible” Mean?

You’re dual eligible if you qualify for Medicare (usually by age 65 or disability) and also meet your state’s Medicaid income and asset rules. Medicare is federal and mainly covers medical services; Medicaid is run by states and is designed to help people with low incomes pay for health care and long-term services.

Being dual eligible doesn’t give you a third program. Instead, Medicaid helps pay for what Medicare doesn’t fully cover, and in some cases adds extra benefits.

Types of Dual Eligibility

Dual eligibility is often grouped into two broad categories:

• Full dual eligible
  You qualify for full Medicaid benefits in your state. Medicaid may:

  • Pay your Medicare Part A and Part B premiums
  • Cover deductibles, coinsurance, and copayments you’d normally owe
  • Include extra benefits Medicare doesn’t cover, such as some long‑term care, personal care services, or non‑emergency medical transportation, depending on your state

• Partial dual eligible
  You qualify for a Medicare Savings Program (MSP) but not full Medicaid. In these cases, Medicaid mainly helps with Medicare costs, such as:

  • Paying the Part B premium
  • Sometimes helping with Part A premiums, if you owe one
  • In some MSP categories, helping with Medicare deductibles and coinsurance

The specific category (such as QMB, SLMB, QI, or QDWI) depends on your income and resources and determines which costs are covered.

How Medicare and Medicaid Work Together

When you’re dual eligible:

• Medicare usually pays first for covered services.
• Medicaid may pay second, filling in some or all of your remaining costs, based on your eligibility level and state rules.
• You still keep your Medicare rights and choices, including Original Medicare or a Medicare Advantage plan.

Many dual eligible people enroll in Dual Eligible Special Needs Plans (D‑SNPs), a type of Medicare Advantage plan tailored to those with both Medicare and Medicaid. These plans coordinate benefits and may include extra features like dental or vision, but you can also stay with Original Medicare if you prefer.

Why Dual Eligibility Matters

For people with low incomes, dual eligibility can:

• Greatly reduce or eliminate monthly Medicare premiums
• Lower out‑of‑pocket costs at the doctor, hospital, or pharmacy
• Open access to services Medicare doesn’t fully cover, especially for ongoing care needs

If you think you might qualify, the next practical step is to apply for Medicaid or a Medicare Savings Program through your state’s Medicaid office. Getting approved for any level of dual eligibility can make your Medicare coverage much more affordable and comprehensive.