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If you’re “dually eligible,” that means you qualify for both Medicare and Medicaid. You may be able to get full Medicaid benefits or help paying certain Medicare costs. Together, these two programs can give you access to more services and help make health care more affordable.
That extra support can make a big difference when you’re an older adult living on a tight budget. But it’s important to know that having Medicare doesn’t automatically mean you qualify for Medicaid.
Keep reading to learn how dual eligibility works, who falls into that category, and where to get help understanding your options.
Dual Eligibility at a Glance
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What does dual eligibility mean? |
You qualify for Medicare and Medicaid at the same time. |
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Who qualifies? |
People with Medicare who meet their state’s requirements for full Medicaid benefits or a Medicare Savings Program (MSP). |
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How do the programs work together? |
Medicare pays first for services it covers. Depending on your eligibility, Medicaid may help pay Medicare costs and cover additional services, including long-term care. |
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How do I apply? |
If you already have Medicare, contact your state Medicaid agency to apply for Medicaid or the MSPs. |
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Where can I get help? |
Contact your local SHIP for free counseling or your state Medicaid agency for help applying. |
How do Medicare and Medicaid work together?
Together, Medicare and Medicaid can expand the types of health care services you receive and lower your out-of-pocket costs:
- Medicare pays first for covered health care services, such as doctor visits and hospital stays.
- Medicaid acts as a secondary payer or wraparound coverage. It can help cover Medicare out-of-pocket costs, like copayments and deductibles. It may also provide additional benefits that Medicare doesn't, such as hearing care, vision care, and dental care.1
What’s more, Medicaid pays 100% of nursing home costs for people who qualify. That’s a good thing, because Medicare doesn’t cover it.
“It’s natural to assume that the largest federal health insurance program for Americans age 65 and up would include long-term care,” explained Jen Teague, NCOA Director for Health Coverage and Benefits. “But the reality is, Medicare will only cover up to 100 days in a skilled nursing facility.”2
Long-term care coverage is vital. As we get older, many of us will need it, whether at home or in a skilled nursing facility. But this care isn’t cheap. According to CareScout’s 2025 Cost of Care study, a semi-private room in a nursing home can run as much as $9,581 per month.3
Depending on the type of dual-eligible coverage you choose, you may also have access to a care coordinator who can help you understand your Medicare and Medicaid benefits, schedule appointments, connect with providers, and navigate the health care system.
Did You Know?
| If you qualify for Medicare and full Medicaid benefits, Medicaid may help cover long-term care that Medicare doesn’t pay for. |
Who qualifies for both Medicare and Medicaid?
According to the Centers for Medicare & Medicaid Services (CMS), you may qualify for dual eligible benefits if:4
- You are enrolled in original Medicare (Part A, Part B, or both), and
- You receive full Medicaid benefits, or
- You get help with your Medicare out-of-pocket costs through a Medicare Savings Program (MSP).
To learn more about becoming dual-eligible, read this NCOA article that plainly describes the two most common ways Medicare beneficiaries can also qualify for Medicaid. If you’re one of them, you’ll be in good company: 12 million people are eligible for and enrolled in Medicare and Medicaid in the U.S.5
What are the income and asset limits for dual eligibility?
Everyone who meets the criteria for Medicare can enroll in the program, regardless of income. That means dual eligibility solely depends on whether or not you meet the income requirements for Medicaid.
Since each state operates its own Medicaid program, guidelines vary.
In Massachusetts, for instance, if you have Medicare and are single, you may qualify for help paying Medicare premiums and other out-of-pocket costs through the Qualified Medicare Beneficiary (QMB) Medicare Savings Program if your monthly income is $2,547 or less in 2026. There’s no asset limit, but other eligibility requirements apply.
But the rules can be complex, Teague warned, and income limits depend on whether you are applying for full Medicaid or for one of the four Medicare Savings Programs.
“The best way to see if you qualify for Medicaid is to reach out to your state's Medicaid office,” Teague said. To find Medicaid contact information for your state, visit the Medicaid website.
You can also visit HealthCare.gov to check if you qualify for Medicaid based on your income.
Find Health Care Assistance Near You
Learn more about benefits assistance programs in your area that can help you save money on health care, preventative services, prescriptions, and more.
What’s the difference between full and partial dual eligibility?
The difference lies in how much help you get from Medicaid. Full dual eligibility means you have Medicare and qualify for full Medicaid benefits. Beyond helping with certain Medicare costs, Medicaid may cover services Medicare doesn’t, such as long-term care. Your benefits depend on your state and eligibility.
Partial dual eligibility means you have Medicare and qualify for help paying certain Medicare costs through a Medicare Savings Program, but you don’t get full Medicaid benefits. Depending on the program, that help may cover premiums, deductibles, coinsurance, and copayments (or just premiums).
How do I apply for dual Medicare and Medicaid?
You’ll need to apply for each program separately. If you already have Medicare, reach out to your state Medicaid agency to apply for Medicaid. There’s no separate application for “dual eligibility”—it just means you qualify for both programs.
When you contact your state agency, ask about both full Medicaid coverage and Medicare Savings Programs, which can help pay some of your Medicare costs. The agency will review your application to see what help you qualify for.
Not sure you’ll qualify? It’s still worth applying. The rules vary by state, and some of your income and savings may not count toward the limits.
Click through to learn how to:
Will I lose my Medicaid if I get Medicare?
Not necessarily. Enrolling in Medicare when you turn 65 does not affect your existing Medicaid coverage as long as you continue to meet your state’s Medicaid eligibility requirements. (But if you're getting Medicaid through your state's expansion program, you may need to reapply for traditional Medicaid once you become Medicare-eligible.)
One common exception? If you begin collecting Social Security, and the increase to your income bumps you above the allowable limit.
“It may sound complicated, but don’t let that get in the way of applying for and enrolling in the benefits you deserve,” Teague said. Your local State Health Insurance Assistance Program (SHIP) offers no-cost guidance to help you navigate dual eligibility.
Do I have to join a special plan if I have Medicare and Medicaid?
No. Having both Medicare and Medicaid doesn’t mean you have to join a special Medicare plan. You have several options for coordinating your Medicare and Medicaid coverage and care.
You may choose to maintain separate policies. Or, if one is available in your area, you may enroll in a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan. These privately-run managed care plans combine your Medicare and Medicaid coverage into one policy and often include additional benefits. But they’re not for everyone.
What if I don’t have low income, but still can’t afford to pay for long-term care?
There may be other ways to qualify for dual eligible Medicare and Medicaid benefits, even if you go over your state’s income limits.
But the rules can be complex. That’s why it’s important to consult with a trusted financial or legal professional with expertise in this area, Teague advised.
Who can help me understand my Medicare and Medicaid options?
You don’t have to figure it out on your own. Your local SHIP offers free, personalized counseling to help you understand Medicare, compare coverage options, and learn how Medicare works with Medicaid. Find your SHIP here.
For questions about Medicaid eligibility, benefits, or applying for coverage, contact your state Medicaid agency.
You can also read this article to learn more about coverage options for dual eligibles.
Sources
1. Medicaid.gov. Medicaid Eligibility. Found on the internet at https://www.medicaid.gov/medicaid/eligibility/index.html
2. Medicare.gov. Skilled nursing facility (SNF) care. Found on the Internet at https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
3. CareScout. Cost of Care Survey (2025 Data). Found on the internet at https://www.carescout.com/cost-of-care
4. CMS Medicare Learning Network. MLN Fact Sheet: Beneficiaries Dually Eligible for Medicare and Medicaid, June 2024. Found on the internet at https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/medicare_beneficiaries_dual_eligibles_at_a_glance.pdf
5. 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/
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