Medicaid and Medicare Dual Eligibility

Quick answer: “Dual eligibles” have both Medicare and Medicaid. Medicare pays first for hospital and medical care, while Medicaid helps with Medicare premiums and cost-sharing — often through Medicare Savings Programs — and covers services Medicare does not, especially long-term care. Eligibility and benefits vary by state.

Key takeaways

• Dual eligibles are enrolled in both Medicare and Medicaid at the same time.
• Medicare pays first; Medicaid acts as a secondary payer and fills gaps.
• Medicaid can pay the 2026 Medicare Part B premium of $202.90 and other cost-sharing via Medicare Savings Programs.
• Medicaid covers long-term care, which Medicare generally does not.
• Dual Eligible Special Needs Plans (D-SNPs) coordinate both programs for many duals.

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. Dual eligibles 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 Medicare Part B premium — $202.90 per month in 2026 — and, at the highest tier, your Medicare deductibles, coinsurance, and copays. The Qualified Medicare Beneficiary (QMB) program offers the most protection, while the SLMB and QI programs pay the Part B premium for people with somewhat higher income.

The 2026 monthly income limits for these programs are national anchors, shown in the table below. Asset limits also apply to MSPs; rather than a single number, check the current asset figures on Medicare.gov. Many people who qualify never enroll simply because they do not know these programs exist — if your income is modest and you have Medicare, it is worth checking.

Program	2026 monthly income limit (single)	2026 monthly income limit (couple)	What it pays
QMB (Qualified Medicare Beneficiary)	$1,350	$1,824	Part B premium plus deductibles, coinsurance, copays
SLMB (Specified Low-Income Medicare Beneficiary)	$1,616	$2,184	Part B premium
QI (Qualifying Individual)	$1,816	$2,455	Part B premium
Medicare Part B premium (2026)	$202.90 per month		Paid by MSP if eligible

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.

People Also Ask

Can you have both Medicare and Medicaid?

Yes. People with both are called dual eligibles. This happens when someone has Medicare through age or disability and also meets their state’s Medicaid income and asset limits. Medicare pays first for most care, and Medicaid helps with premiums, cost-sharing, and services Medicare does not cover, like long-term care.

Does Medicaid pay my Medicare premium?

It can. Through the Medicare Savings Programs, Medicaid may pay your Medicare Part B premium — $202.90 monthly in 2026 — and, under the QMB program, your deductibles and copays too. Eligibility depends on income and assets. Check your state Medicaid agency and Medicare.gov to see if you qualify.

Who pays first, Medicare or Medicaid?

Medicare pays first. For dual eligibles, Medicare is the primary payer for covered hospital, medical, and drug costs, and Medicaid is the secondary payer that helps with remaining cost-sharing and covers additional services Medicare excludes, such as long-term care. This coordination reduces or eliminates out-of-pocket costs for many duals.

What is a D-SNP?

A Dual Eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan built for people who have both Medicare and Medicaid. It coordinates benefits from both programs in one plan, often adding care management and extra benefits. Availability depends on your area; check Medicare.gov and your state Medicaid agency for options.

Does dual eligibility cover long-term care?

Yes, through Medicaid. Medicare covers only limited short-term skilled nursing, but Medicaid is the primary payer for ongoing nursing-home and home-based long-term care. Dual eligibles who need long-term care rely on the Medicaid side of their coverage. Eligibility and covered services vary by state, so confirm with your state Medicaid agency.

Official sources

• Medicare.gov — Medicare Savings Programs (.gov)
• Medicaid.gov — Dual eligibility and your state (.gov)
• HealthCare.gov — Coverage information (.gov)

Reviewed by the Guru Gazette Editorial Review Team · Last reviewed June 2026. Figures are verified against official government sources; see our Fact-Checking Policy.