Medicaid and Medicare Dual Eligibility

What Dual Eligibility Means

Some people qualify for both Medicare and Medicaid and are called “dual eligibles.” This usually happens when someone has Medicare — through age 65 or a disability — but also has income and assets low enough to qualify for Medicaid under their state’s rules. About 12 million Americans are dual eligibles, more than 15% of everyone on Medicaid, and they get the most complete coverage available in the U.S. system because the two programs work together, each doing what it does best.

The basic division of labor is simple: Medicare is the primary payer for hospital stays, doctor visits, and prescription drugs, and Medicaid is the secondary payer that helps with costs Medicare leaves behind and covers services Medicare excludes. To understand each program on its own, see the Medicare 2026 guide and the Medicaid 2026 guide, or compare them directly in Medicare vs. Medicaid.

How Medicaid Helps Pay Medicare Costs

For many duals, the most valuable help comes through the Medicare Savings Programs (MSPs), which are run by Medicaid. Depending on income, an MSP can pay your monthly Medicare Part B premium (confirm the current amount on Medicare.gov, since it is set annually) and, at the highest tier, your Medicare deductibles, coinsurance, and copays. The Qualified Medicare Beneficiary (QMB) program offers the most protection — and under QMB, providers are not allowed to bill you for Medicare cost-sharing — while the SLMB and QI programs pay the Part B premium for people with somewhat higher income.

The 2026 monthly income limits below apply in the 48 states and DC and include the standard $20 disregard; some states use more generous standards. Resource limits also apply: $9,950 for an individual and $14,910 for a couple in 2026.

Source: Medicare.gov; Medicaid.gov; CMS bulletins (2026). Income limits include a $20 disregard. Resource limits $9,950 / $14,910 also apply. States may use more generous rules.

What Medicaid Covers That Medicare Does Not

Beyond cost-sharing, Medicaid covers important services Medicare leaves out. The biggest is long-term care: Medicare pays only for limited short-term skilled nursing, while Medicaid is the nation’s primary payer for ongoing nursing-home and home- and community-based care. Depending on the state, Medicaid may also cover dental, vision, hearing, transportation to medical appointments, and personal-care services. For seniors, this combination is explained further in Medicaid for seniors.

Many dual eligibles choose a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed to coordinate Medicare and Medicaid benefits in one place, often with extra benefits and care management. Whether a D-SNP is available depends on your area. Disabled adults who are duals should also read Medicaid for disabled adults and, if they work, Medicaid Buy-In programs.

How to Become a Dual Eligible

If you already have Medicare, the way to add Medicaid is to apply through your state Medicaid agency or to apply for a Medicare Savings Program. Eligibility depends on your state’s income and asset rules, so confirm the details with your state agency through Medicaid.gov and check the MSP rules on Medicare.gov. When you are ready, our guide on how to apply for Medicaid walks through the documents you will need, and the income limits guide explains where you stand.

Sources

• Medicaid.gov — Seniors & Medicare-Medicaid Enrollees
• Medicare.gov — Medicare Savings Programs
• CMS — Informational Bulletin, Jan 23, 2026 (2026 MSP income standards)
• CMS — Informational Bulletin, Dec 9, 2025 (2026 MSP resource standards)
• Medicaid.gov — Long-Term Services & Supports

Last fact-check: July 29, 2026

Editorial status: Independent subject-matter review has not been completed.