Copayments. Deductibles. Premiums. If you're at least 65 and living on a low fixed income, you know how quickly health care expenses can stack up. That’s why it’s important to learn about Medicare-Medicaid dual eligibility—a critical benefit that can expand your coverage and lower your out-of-pocket costs.

What does it mean to be dual eligible? And how do you apply for dual Medicare and Medicaid if you qualify? This guide is designed to simplify the process and help you claim all the benefits you're entitled to.

What is Medicare-Medicaid dual eligibility? Who qualifies?

Being dual eligible means you qualify to enroll in both Medicare and Medicaid at the same time. Medicare acts as the primary payer, covering hospital stays, doctor visits, and other health care services as shown below:

• Part A (Hospital Insurance): Pays for hospital stays as well as short-term stays at skilled nursing facilities
• Part B (Medical Insurance): Covers doctor visits, outpatient hospital care, and home health care services not covered by Part A
• Part D (Prescription Drug Coverage): A separate plan from a private insurer that helps pay for prescription medications

Where does Medicaid come in? For dual-eligible older adults, Medicaid acts as a second layer of coverage. It steps in to help with costs Medicare doesn’t fully cover—such as premiums, copays, long-term nursing home care, and even routine dental care, hearing aids, and eyeglasses. Without Medicaid, you would be responsible for these costs out of your own pocket.

Before you apply for dual Medicare and Medicaid, you should take the time to understand the programs’ eligibility guidelines. Medicare eligibility is based on age, disability status, and having certain medical conditions. With Medicaid, you must have limited income and assets to qualify.

Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits, recommends that all older adults with low income check if they’re dual eligible. “Dual eligible status can bring considerable relief to people with limited means,” he explained.

It’s also worth noting that fully dual-eligible adults automatically qualify for Part D Extra Help. This is a great benefit that helps enrollees pay for their prescription medications, valued at around $6,200 a year,” Ramsey said.

How do I apply for Medicare-Medicaid dual enrollment?

As someone who is dual eligible, claiming your benefits generally requires you to apply to each program separately. Here's how to do both.

Step 1: Apply for Medicare

You are eligible for Medicare if you are age 65 or older. You might qualify before age 65 if you have a disability, permanent kidney failure (End-Stage Renal Disease), or ALS (Lou Gehrig’s disease).

How to apply for Medicare

There are three basic ways to apply for Medicare:

• Apply online: Visit SSA.gov/Medicare.
• Apply by phone: Call the Social Security Administration (SSA) at 1-800-772-1213.
• Apply in person: Visit your local Social Security office. Note that you may need an appointment before visiting an office in person and this option could take longer than if you were to use SSA's website.

Are you already receiving Social Security benefits? There’s no need to file a separate application; you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Approximately three months before your birthday, you’ll receive your red, white, and blue Medicare card in the mail.

Step 2: Apply for Medicaid

You may qualify for Medicaid if you have limited income and assets that fall within your state’s specific guidelines. In most states (but not all), if you receive Supplemental Security Income (SSI), you’ll be automatically enrolled. This means you may not need to submit a separate Medicaid application (but it’s still smart to confirm with your local Medicaid office).

Also, if you’re interested only in getting help with your Medicare out-of-pocket costs through one of the Medicare Savings Programs (this is called “partial dual eligibility”), you do not need to file a separate Medicaid application. Instead, the Medicare Savings Program (MSP) application doubles as your Medicaid application for those specific benefits. Depending on which plan you’re enrolled in, an MSP can put thousands of dollars back into your budget for everyday needs like groceries and utilities. Three of the four MSPs cover the Medicare Part B premium—saving you $185 per month in 2025, or $2,220 per year. Plus, MSP enrollment automatically qualifies you for the Part D Extra Help benefit, which provides additional yearly savings.

Those interested in full Medicaid benefits and Medicare (this is called “full dual eligibility”) must file a separate Medicaid application.

How to apply for Medicaid

There are several ways to apply for Medicaid:

• Apply online: Visit your state’s Medicaid website or go through the Health Insurance Marketplace.
• Apply by phone: Call your state Medicaid office.
• Apply in person: Visit your local Medicaid or social services office.

After you apply for Medicaid

Once you submit your Medicaid application, your state agency will review your income, assets, and other eligibility factors. You may be asked to provide supporting documents such as:

• Proof of birth date (e.g., birth certificate)
• Proof of U.S. citizenship or lawful residence (e.g., driver's license, passport, green card)
• Proof of residence (e.g., deed, rent receipts) 
• Proof of earned and unearned income (e.g., pay stubs, Social Security benefits statement)
• Proof of assets (e.g., bank statements, life insurance policies)
• Your Medicare card (and any other insurance cards)

A Medicaid decision typically takes up to 45 business days, though many states will process applications faster. If your application is approved, you’ll receive a decision notice confirming your Medicaid enrollment and how much you’ll have to pay toward your costs (cost sharing).

If you apply for dual Medicare and Medicaid and your Medicaid application is denied, you’ll get a letter explaining the reason—and how to appeal the decision.

You can check your application status anytime by contacting your state Medicaid agency.

If your application is denied for Medicaid

Don’t give up. Many older adults are approved for Medicaid after appealing or exploring other options. It’s important to advocate for yourself (or an older adult you care for).

Here are some actions you can take:

• Request a fair hearing: Follow the instructions provided in your denial notice. You often have 30 days to request a Medicaid fair hearing (but some states allow up to 90 days).
• Explore Medicaid spend-down programs: If your income is slightly above the limit, you may qualify for a Medicaid spend-down program (also called Medically Needy Medicaid). This involves using your medical bills to “spend down” to the income level that meets Medicaid eligibility requirements.
• Ask about Medicaid waiver programs: Offered by nearly all states, Medicaid waivers can expand access to medical and non-medical services (e.g., home health care, meal delivery, transportation) even if your income or assets are higher than your state’s limits.

Explore more options if your income is too high for full dual eligibility.

Need help applying for dual Medicare and Medicaid?

With so many rules and requirements to sift through, navigating both of these programs can seem complicated. But help is yours for the asking.

Medicare.gov and your state Medicaid agency are good resources for expert information and guidance. You can also contact your State Health Insurance Assistance Program (SHIP) for trustworthy advice. SHIP counselors are well-versed in how to apply for dual Medicare and Medicaid coverage. They can tell you if you meet eligibility requirements and, if you do, walk you through the application process for each program step by step.