Can You Get Both Medicare and Medicaid? Dual Eligibility

Healthcare coverage is a critical concern for millions of Americans, especially as they age or face chronic health conditions. A common question that arises is: can you get both Medicare and Medicaid? The short answer is yes, and this combination can provide comprehensive financial protection and access to care. However, the rules, benefits, and application process can be complex. This article explains everything you need to know about dual eligibility, the coverage you receive, and how to apply.

Understanding the Basics of Medicare and Medicaid

Before diving into dual eligibility, it helps to understand what each program does. Medicare is a federal health insurance program primarily for people aged 65 and older, as well as younger individuals with certain disabilities or End-Stage Renal Disease (ESRD). It is divided into Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Medicaid, on the other hand, is a joint federal and state program that provides health coverage to people with limited income and resources. It covers a broader range of services than Medicare alone, including long-term care, personal care services, and some dental and vision benefits. Each state administers its own Medicaid program within federal guidelines, so eligibility and benefits can vary.

When someone qualifies for both programs, they become a “dual eligible” beneficiary. This status can significantly reduce out-of-pocket costs and fill gaps in coverage that each program alone might leave. For a deeper look at how these programs work together, see our guide on Medicare and Medicaid at the same time.

Who Qualifies for Dual Eligibility?

To be eligible for both Medicare and Medicaid, you must first meet the criteria for each program individually. For Medicare, you generally need to be 65 or older, or have a qualifying disability or ESRD. For Medicaid, you must meet income and asset limits set by your state.

There are several categories of dual eligibility:

• Full Dual Eligible: You qualify for full Medicaid benefits, meaning Medicaid covers most out-of-pocket Medicare costs (premiums, deductibles, copayments) and may provide additional services like long-term care.
• Partial Dual Eligible (Medicare Savings Programs): You have limited income and resources, so Medicaid helps pay for Medicare premiums and sometimes cost-sharing, but does not provide full Medicaid benefits. These programs include Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs.
• Medicare-Medicaid Dual Eligible Special Needs Plans (D-SNPs): These are Medicare Advantage plans specifically designed for dual eligibles. They coordinate Medicare and Medicaid benefits into one plan, often with extra benefits like dental, vision, and transportation.

Income limits for Medicaid vary by state. For example, in 2026, a single person in a state that expanded Medicaid under the Affordable Care Act might qualify for full Medicaid with income up to 138% of the Federal Poverty Level (FPL). However, for partial dual eligible programs, income limits are typically lower, around 100% to 135% of FPL. Asset limits also apply, though some states have eliminated them for certain groups. Check with your state Medicaid agency for exact numbers.

How Dual Coverage Works: The Benefits of Being a Dual Eligible

When you have both Medicare and Medicaid, Medicare is always the primary payer. That means Medicare pays first for services it covers, and then Medicaid pays second, covering most or all of the remaining costs. This coordination can eliminate nearly all out-of-pocket expenses for covered medical services.

Here are key benefits of dual eligibility:

• Zero or minimal premiums: Medicaid typically pays your Medicare Part B premium (which is $174.70 per month in 2026 for most people). If you qualify for full Medicaid, it may also pay Part A and Part D premiums.
• No deductibles or copays: For most Medicare-covered services, Medicaid covers the deductibles and coinsurance. For example, a hospital stay that would normally require a $1,632 deductible under Part A may cost you nothing.
• Extra coverage: Medicaid often covers services Medicare does not, such as long-term nursing home care, personal care assistance, dental services, vision exams, eyeglasses, hearing aids, and non-emergency medical transportation.
• Prescription drug help: Dual eligibles automatically qualify for Extra Help, a federal program that lowers prescription drug costs under Medicare Part D. This means you pay no more than a small copayment for most generic and brand-name drugs.

These benefits can be life-changing for people with chronic conditions or limited incomes. For instance, someone with diabetes might use Medicare for doctor visits and insulin, while Medicaid covers the cost of diabetic shoes, nutritional counseling, and transportation to appointments. The combination ensures they receive comprehensive care without financial strain.

How to Apply for Dual Eligibility

Applying for dual eligibility involves two separate processes: enrolling in Medicare and applying for Medicaid. You can start with Medicare if you are turning 65 or have a disability. Most people are automatically enrolled in Medicare Part A and Part B after receiving Social Security benefits for 24 months or after turning 65. If you are not automatically enrolled, you can apply through the Social Security Administration.

To apply for Medicaid, you must contact your state’s Medicaid agency. The application process usually involves submitting proof of income, assets, age, and citizenship or legal residency. Many states allow you to apply online through their health insurance marketplace or directly through the state Medicaid office. If you qualify for a Medicare Savings Program, you can often apply through your state’s Medicaid office as well.

It is important to note that you do not need to apply for both at the same time. If you already have Medicare and later become eligible for Medicaid due to a change in income, you can apply for Medicaid at any time. Similarly, if you have Medicaid and then become eligible for Medicare (for example, by turning 65), you should enroll in Medicare during your Initial Enrollment Period to avoid late penalties. For more detailed steps, read our article on Medicare and Medicaid eligibility.

Common Misconceptions and Pitfalls

One common misconception is that having both Medicare and Medicaid means you automatically get all services for free. While out-of-pocket costs are greatly reduced, some services may still require small copayments, especially for prescription drugs or non-covered services. Also, not all providers accept both Medicare and Medicaid, so it is important to check with your doctor or hospital before receiving care.

Another pitfall is failing to update your information when your income or assets change. If your financial situation improves, you may lose Medicaid eligibility but still qualify for a Medicare Savings Program. Conversely, if your income drops, you might qualify for more benefits. Always report changes to your state Medicaid agency promptly to avoid gaps in coverage or overpayment issues.

Finally, be aware that dual eligible status does not automatically enroll you in a D-SNP. You can choose to stay in Original Medicare with a Medigap policy (though Medigap may be less beneficial when you have Medicaid) or enroll in a Medicare Advantage plan. If you want the coordination and extra benefits of a D-SNP, you must actively select one during enrollment periods. For more on this, see our explanation of dual eligibility explained.

Frequently Asked Questions

Can I have both Medicare and Medicaid at the same time?

Yes, this is called dual eligibility. It allows you to receive comprehensive coverage with very low out-of-pocket costs because Medicare pays first and Medicaid covers most remaining expenses.

Does Medicaid pay my Medicare Part B premium?

If you qualify for full Medicaid or a Medicare Savings Program (like QMB), Medicaid will pay your Part B premium. In some cases, it may also pay Part A and Part D premiums.

Do I need to choose between Medicare and Medicaid?

No, you can keep both. Medicare remains your primary insurance, and Medicaid acts as secondary coverage to fill gaps.

What is a Dual Eligible Special Needs Plan (D-SNP)?

A D-SNP is a Medicare Advantage plan designed for people who have both Medicare and Medicaid. It coordinates benefits from both programs and often includes extras like dental, vision, and over-the-counter allowances.

How do I find providers who accept both Medicare and Medicaid?

You can use the Medicare.gov Physician Compare tool or call your state Medicaid office. Many D-SNPs have networks of providers who accept both, so enrolling in a D-SNP can simplify this process.

Getting Help with Your Dual Coverage

Navigating dual eligibility can be confusing, but you do not have to do it alone. State Health Insurance Assistance Programs (SHIPs) offer free, unbiased counseling to Medicare beneficiaries and their families. You can also contact your local Area Agency on Aging for guidance. Additionally, licensed insurance agents can help you compare D-SNP options and enroll in a plan that meets your needs.

For personalized assistance, NewMedicare.com provides tools to compare plans and connect you with licensed agents. We also offer up-to-date information on enrollment periods and costs. For a complete overview of your options, check out our resource on having Medicare and Medicaid together.

Being a dual eligible beneficiary can significantly reduce your healthcare costs and improve access to care. By understanding the rules, benefits, and application process, you can make the most of both programs. If you think you might qualify, take the first step today by contacting your state Medicaid office or speaking with a Medicare specialist. With the right information and support, you can secure the coverage you deserve.