Chances are you’re familiar with Medicare and Medicaid—two important health insurance programs serving older Americans. While both programs are government-sponsored, Medicare and Medicaid offer distinctly different types of support. If you qualify for both, you’ll join roughly 13.7 million older adults who are referred to as “dual eligible.”¹

Being dual eligible puts you in a unique category, allowing you to be enrolled in Medicare (a federal program) and Medicaid (a joint federal and state program) at the same time.

But qualifying for both programs isn’t easy; it depends heavily on your monthly income level. Keep reading to learn about dual eligible income limits for older adults and who qualifies for dual eligibility.

What does it mean to be dual eligible?

Dual eligibility can substantially reduce your out-of-pocket health care costs and connect you to extra services that help you age well. As a dual-eligible beneficiary, you receive benefits from both Medicare and Medicaid:

• Medicare typically covers:
  • Hospital visits (Part A)
  • Doctor appointments and outpatient care (Part B)
  • Prescription drugs (separate Part D plan)
• Medicaid helps pay for:
  • Medicare premiums, copays, and coinsurance
  • Long-term care in a nursing home or in-home care services
  • Extra services like dental, vision, and transportation

If you’re dual eligible, you could save thousands each year in out-of-pocket medical costs while benefiting from a wider range of care. But first, you must meet certain income requirements.

What are the dual eligible income limits for older adults?

Because Medicare is not income-based, it’s the Medicaid side that determines if you qualify for dual eligible status.

What is the maximum income for seniors to qualify for Medicaid?

“To qualify for Medicaid, your income must fall within a specific range, and those limits are strict,” said Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. “Although Medicaid income limits are primarily based on the federal poverty level (FPL), states have the freedom to set their own limits and even create different categories of eligibility.”

Many states also look at your assets (or resources), such as money in the bank or property other than your home.

The good news is there are multiple pathways to dual eligibility—each with its own set of rules. So, if you don’t meet the guidelines for one Medicaid pathway, you might meet the requirements for another.

What are the main pathways to dual eligibility?

Older adults can qualify for Medicaid and dual eligibility several different ways:

1. Supplemental Security Income (SSI)

Supplemental Security Income is a federal program for people who are age 65+ or have disabilities and meet very strict income and asset limits. In most states, if you receive SSI, you're automatically eligible for Medicaid. Among the 9.7 million dual-eligible older adults who have full Medicaid, 47% qualify through SSI—the only mandatory pathway.²

In 2025, the federal income limit for SSI is:

• $967 per month for an eligible individual
• $1,450 per month for an eligible couple

Keep in mind these limits may be higher depending on your state.

2. Low-income Medicaid

Many older adults and people with disabilities who don't qualify for SSI may still be able to get Medicaid if their income is up to 100% of the FPL. This is the most common pathway to full Medicaid, offered by 28 states.²

In 2025, 100% of the FPL is:

• $1,304.17 per month for an individual
• $1,762.50 per month for a couple

Income limits differ by state. Also, not all of an applicant's income may be counted toward their income eligibility. Part of this income may be “disregarded.” These income disregards are not necessarily applied in all states, nor are they applied for all long-term care Medicaid programs within any given state. It’s best to check with your local Medicaid office to learn what limits and disregards your state has set.

3. Medically Needy Medicaid

Even if your income exceeds the Medicaid income limit, you may still qualify if your medical expenses are very high. This eligibility category is called Medically Needy Medicaid or “Medicaid spend-down.” With a Medicaid spend-down program, your monthly medical bills are subtracted from your income until your income drops to your state’s Medicaid limit. At that point, you may temporarily qualify for coverage.

Available in many states, the Medically Needy option can be a lifeline for older adults facing major health care costs.

4. Buy-in programs

What if your income is slightly too high for full dual eligibility? You may be able to “buy into” Medicaid to lower your countable income. Medicaid buy-in programs are designed for:

• Adults with disabilities who are working
• People who need Medicaid to pay for certain services, but don’t qualify under other categories

Buy-in options vary widely by state and may require payment of monthly premiums.

5. Long-term services and supports (LTSS)

Long-term services and supports refer to a range of services that help people—especially older adults and people with disabilities—manage daily living tasks. The goal is to support and prolong independence, whether at home, in the community, or in a care facility like a nursing home.

If you need long-term care, Medicaid may help cover the costs even if your income is higher than the regular limit. In many cases, states permit higher income thresholds or offer Medicaid waivers to cover specific services for people who need them.

6. Medicare Savings Programs (MSPs)

Medicare Savings Programs are special Medicaid programs that help cover Medicare out-of-pocket costs like premiums, deductibles, and coinsurance. Almost all dual-eligible people with partial Medicaid qualify through the MSPs.

There are four main MSPs, each with their own income limits (limits are slightly higher in Alaska and Hawaii):

Some states have income and/or asset limits higher than the federal limits. That means even if you don’t meet the limits shown above, you may still qualify for dual eligibility through an MSP.

Enrollment in an MSP can free up thousands of dollars in your budget to pay for essentials like food and utilities. Three of the four MSPs cover the Part B premium, which in 2025 is $185 a month for most people—for a total savings of $2,220 each year. MSP enrollment also automatically qualifies you for the Part D Low Income Subsidy (Extra Help). Extra Help helps cover the cost of your prescription medications and has an estimated annual value of $6,200.

How is income calculated for Medicaid?

Each state calculates income a bit differently. But in general, Medicaid looks at your countable income.

Countable income includes (but is not limited to):

• Social Security, disability, or veterans benefits
• Wages or pensions
• Retirement account withdrawals

Some income may be excluded, such as:

• SSI payments
• Supplemental Nutrition Assistance Program (SNAP) benefits
• Federal housing assistance
• Energy assistance

Asset (resource) limits

In addition to income, Medicaid also has asset limits. Assets typically include things like:

• Cash savings
• Stocks and bonds
• Certificates of deposit
• Real property (other than your primary residence)
• Second homes or vehicles

But some assets are not counted, such as:

• Your primary home (if you live in it)
• One vehicle
• Personal belongings and household goods
• Life insurance with a face value under $1,500
• Up to $1,500 set aside for burial expenses

Most state Medicaid programs have an asset limit of $2,000 for an individual or $3,000 for a married couple. Some states may set higher amounts or have waivers with different guidelines.

How do I know if I qualify for dual eligibility?

Understanding the income limits for dual Medicare and Medicaid—and how they affect you—is an important first step in determining dual eligibility. For guidance, it’s a good idea to talk to someone with expertise in this area:

• Reach out to your state Medicaid office.
• Call Medicare directly at 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048.
• Contact your local State Health Insurance Assistance Program (SHIP) for free, one-on-one help from a trained counselor.
• Consult a trusted financial or legal adviser, especially if you have complex assets or income sources.

“Dual eligibility is an important way many older adults can expand their health care benefits and protect their financial well-being," said Ramsey. “But the rules can be complicated. Talking to an expert can save you valuable time and help ensure you get the full scope of coverage and benefits you’re entitled to.”

Learn More: What Are the Coverage Options for Dual Eligible Older Adults?​​​​​​​

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