Dually Eligible for Medicare and Medicaid: What Are My Coverage Options?

If you’re eligible for both Medicare and Medicaid, you’re considered “dual-eligible.” Roughly 12 million older adults get help from these two government programs.¹ Together, Medicare and Medicaid can provide more complete, affordable coverage by helping to pay for health care, prescription medicines, long-term care, and many other benefits.

People who are dual-eligible have several options for receiving their Medicare and Medicaid benefits. Some keep them separate, while others choose a plan or program that coordinates the two. Knowing what these options are can help you simplify your care, lower your costs, and get all the benefits you’re entitled to. 

Read on to explore the main coverage options available to dual-eligible older adults—from traditional Medicare and Medicaid plans to streamlined programs that roll both plans into one.

Dual-Eligible Coverage Options at a Glance

What are the Medicare coverage options for dual-eligible beneficiaries?

If you’re dual-eligible, you can choose from several types of Medicare coverage. Note: Not every coverage arrangement is available in every state.

Traditional Medicare

Traditional Medicare (also called “original Medicare”) is the main Medicare program run by the federal government. It includes:

• Part A (Hospital Insurance): Part A covers hospital stays, skilled nursing care, and some home health services.
• Part B (Medical Insurance): Part B covers doctor visits, outpatient care, preventive services, lab tests, and more.
• Part D (Prescription Drug Coverage): Part D is optional drug coverage (you must choose and enroll in a separate plan). But unless you have other creditable drug coverage, failure to enroll in Part D when you’re eligible will result in a penalty that will last as long as you have Medicare coverage. If you are fully dual-eligible, you automatically qualify for the Low-Income Subsidy (LIS), also called Extra Help. This means you benefit from lower out-of-pocket drug costs and no Part D late enrollment penalty.  

If you also have Medicaid, those benefits can help pay for what Medicare doesn’t cover, like deductibles, coinsurance, and copayments (also called “out-of-pocket costs”). Medicaid may also provide extra benefits, such as non-emergency medical transportation and long-term care services.

Accountable Care Organizations (ACOs)

Some dual-eligible older adults are enrolled in an Accountable Care Organization (ACO). ACOs are groups of doctors, hospitals, and other providers who work together holistically to improve care quality and coordination for Medicare patients. They may lead to better health outcomes, less paperwork, and smoother communication between providers. ACOs can also broaden beneficiaries’ access to preventive health services and provide additional recovery support following a hospital stay. 

If your provider is part of an ACO, they may be more focused on managing your overall care. This can be especially valuable if you have multiple chronic health conditions.

Medicare Advantage plans

Medicare Advantage (Part C) is an alternative way to get your Medicare benefits. These plans are offered by private insurers and include everything covered under Parts A and B. Most plans also include Part D (prescription drug) benefits.

Beyond core coverages, the majority of Medicare Advantage plans offer some degree of extra benefits as well. These may include:

• Dental, vision, and hearing
• Fitness memberships
• Non-medical transportation
• Home-delivered meals or grocery delivery

For dual-eligible adults, there are special types of Medicare Advantage plans called Special Needs Plans (SNPs). These offer broader Medicare coverage to a specific, limited population with the goal of improving care quality and efficiency. For instance, Dual Eligible Special Needs Plans (D-SNPs) support the needs of dual-eligible members by seamlessly integrating Medicare and Medicaid benefits.

Other types of SNPs that cater to the needs of dual-eligible older adults are:

• Coordination-Only D-SNP: Helps align services without full integration
• Highly Integrated Dual-Eligible SNP (HIDE SNP): Offers more integrated care and added benefits
• Fully Integrated Dual-Eligible SNP (FIDE SNP): Fully combines Medicare and Medicaid, including long-term care

SNPs provide a more streamlined, hassle-free experience that helps dual-eligible adults maximize their benefits. Plus, these plans are more likely than regular Medicare Advantage plans to offer extra services tailored to their members. In addition to dental, vision, and hearing care, they may offer benefits like care coordination and case management services, pre-loaded flex benefits cards, and acupuncture.

Now that we’ve discussed Medicare coverage choices for people who are dual-eligible, let’s see what options you have for receiving your Medicaid benefits.

What is a Dual Eligible Special Needs Plan?

A D-SNP is a type of Medicare Advantage plan that coordinates Medicare and Medicaid benefits for people who qualify for both programs.

What are the Medicaid coverage options for dual-eligible beneficiaries?

Medicaid is managed by each state, so the range of services can differ depending on where you live. But in general, dual-eligible adults can choose from two Medicaid coverage types.

1. Fee-for-service Medicaid. This is the traditional Medicaid system, where the state pays your health care provider directly for services. There is no health plan involved. Fee-for-service Medicaid is often paired with traditional Medicare. It can work well for people who want to choose their own doctors and providers.
2. Medicaid Managed Care. With Medicaid Managed Care, you enroll in a private Medicaid plan that manages your health care. These plans focus on coordinating services and controlling costs. They often work best when paired with a Medicare Advantage plan, especially a D-SNP or FIDE SNP, where services are already coordinated. According to KFF, 78% of Medicaid beneficiaries are enrolled in managed care organizations (MCOs).²

What are single-coverage arrangements for dual-eligibles?

Some dual-eligible adults prefer to have both Medicare and Medicaid combined into a single plan. These programs are called single-coverage arrangements, and they can offer a simpler, more seamless experience.

What types of plans integrate Medicare and Medicaid? We outline two below.

Program of All-Inclusive Care for the Elderly (PACE)

PACE is for people age 55 or older who qualify for nursing-home-level care but want to stay in their homes or communities. This program:

• Combines all Medicare and Medicaid services into one plan
• Provides extra benefits like transportation, meals, personal care, and home services
• Uses a team-based approach to manage your care and help you avoid moving into a nursing facility

PACE is only available in certain areas, and you must live near a local PACE center to join. But it’s a good option if you qualify and prefer to age in place at home.

Medicare-Medicaid All-In-One Plans

All-In-One Plans, previously known as Medicare-Medicaid Plans (MMPs), are state-approved plans that fully integrate Medicare and Medicaid benefits. They typically offer:

• One insurance card
• One care coordination team
• One care manager to help you navigate the system

These simplified plans aim to improve coordination of your Medicare and Medicaid benefits and make your health care easier to manage. 

What are the most common coverage choices for dual-eligible older adults?

Now that you’ve seen what coverage options are available to dual-eligible adults, you may be wondering, “Which options do most people choose?”

According to research data, here’s how dual-eligible adults received their coverage as of June 2025:

• 54.1% were enrolled in specialized Medicare Advantage plans (e.g., D-SNPs)
• 8.9% were enrolled in non-specialized Medicare Advantage plans
• 11.3% were enrolled in accountable care arrangements within fee-for-service Medicare       
• 25.7% were enrolled in non-accountable fee-for-service Medicare³

There’s no “one size fits all” solution for receiving your Medicare and Medicaid benefits. If you want more flexibility in which providers you can see, you may prefer separate Medicare and Medicaid plans. Or, you may like the convenience of having all your benefits in one place with an integrated plan.

Often, the choice boils down to what coverage arrangements are available in your state and what works best for your health and finances. If you need guidance as you navigate your options, help is available.

How can I get help choosing the right dual-eligible coverage option?

As a dual-eligible older adult, there are many ways to get help exploring different coverage possibilities:

• Contact your State Health Insurance Assistance Program (SHIP) to speak with a Medicare counselor (find the program near you).
• Call your state Medicaid office.
• See if there’s a Benefits Enrollment Center (BEC) near you.

When you qualify for both Medicare and Medicaid, you have a unique opportunity to get more complete, coordinated, and affordable care. Understanding your options can empower you to make the most out of both sets of benefits.

"If you’re eligible for both Medicare and Medicaid, know how the two programs can work together is essential,” said Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. “The right coverage arrangement can lower your health care costs, connect you with important services, and make it easier to get the coordinated care you need to stay healthy."

Frequently asked questions (FAQ)

What does it mean to be dual-eligible for Medicare and Medicaid?
It means you qualify for both Medicare and Medicaid at the same time. Medicare usually pays first for Medicare-covered services, while Medicaid may help pay Medicare premiums and out-of-pocket costs and cover additional services. Your benefits depend on whether you have full or partial Medicaid coverage and the rules in your state.

What does Medicare cover if I also have Medicaid?
Medicare is still your primary insurance for Medicare-covered hospital care, doctor visits, preventive services, medical equipment, and prescription drugs. Medicaid typically pays after Medicare. It may help with your premiums, deductibles, copayments, and services Medicare doesn’t typically cover. This may include long-term nursing home care and personal care. Your coverage depends on your state and Medicaid eligibility level. 

Can I have Medicare Advantage and Medicaid at the same time?
Yes. You can enroll in a Medicare Advantage plan and keep your Medicaid coverage if you qualify for both programs. You may also be eligible for a D-SNP, which is a type of Medicare Advantage plan specifically designed to coordinate Medicare and Medicaid benefits. The plans available to you—and their benefits, costs, and provider networks—depend on where you live.

Learn More: What Is Full Dual Eligibility vs. Partial Dual Eligibility?

Sources

1. KFF. A Profile of Dual-Eligible Individuals. July 15, 2026. Found on the internet at https://www.kff.org/medicare/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/

2. KFF. 10 Things to Know About Medicaid Managed Care. March 23, 2026. Found on the internet at https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

3. ATI Advisory. Dual Eligible Enrollment Across Medicare Advantage, ACOs, and Traditional Medicare FFS. Found on the internet at https://atiadvisory.com/dual-eligible-enrollment-dashboard