You can have both Medicare and Medicaid if you meet the eligibility requirements for each program separately. Medicare covers you based on age (65 or older) or disability status, while Medicaid covers you based on low income. When you qualify for both, you’re considered “dual eligible,” and the two programs work together to significantly reduce your out-of-pocket healthcare costs. Roughly 12 million Americans hold this dual status.
Who Qualifies for Both Programs
Medicare and Medicaid have entirely different eligibility rules, and qualifying for both means satisfying each program’s criteria independently. Medicare eligibility comes from being 65 or older, having a qualifying disability, or having end-stage renal disease. That part doesn’t change. The Medicaid side is where things get more complex, because Medicaid is run at the state level and income thresholds vary.
The most common paths to dual eligibility include receiving Supplemental Security Income (SSI), enrolling in a Medicare Savings Program, or qualifying through your state’s Medicaid program for low-income seniors or people with disabilities. Some states also extend Medicaid to people who need long-term care services, such as nursing home care or home-based assistance, even if their income is slightly above standard Medicaid limits.
There are two types of dual-eligible status. “Full dual” means you get the complete range of Medicaid benefits on top of Medicare. “Partial dual” means Medicaid helps pay some of your Medicare costs (like premiums or copays) but doesn’t cover additional services. Which category you fall into depends on your income, your assets, and your state’s rules.
Medicare Savings Programs
Medicare Savings Programs (MSPs) are one of the most accessible ways to become dual eligible. These are Medicaid programs specifically designed to help pay your Medicare costs, and qualifying for any of them gives you a form of dual status. There are four programs, each with different income limits and benefits. All figures below are 2026 limits for the 48 contiguous states.
Qualified Medicare Beneficiary (QMB)
QMB is the most generous Medicare Savings Program. It covers your Part A premiums, Part B premiums, and all Medicare deductibles, coinsurance, and copays. If you have QMB, Medicare providers are not allowed to bill you for any cost-sharing on covered services. To qualify, your monthly income must be at or below $1,350 as an individual or $1,824 as a married couple, with resources (savings, investments, but not your home or car) under $9,950 individually or $14,910 for a couple.
Specified Low-Income Medicare Beneficiary (SLMB)
SLMB covers your Part B premium only. You need both Part A and Part B to qualify. The income limit is $1,616 per month for an individual or $2,184 for a couple, with the same resource limits as QMB.
Qualifying Individual (QI)
QI also covers your Part B premium and has the highest income ceiling of the three main programs: $1,816 monthly for an individual, $2,455 for a couple. One catch: QI requires you to reapply every year, and states approve applications on a first-come, first-served basis, with priority given to people who received QI the previous year. You also can’t receive QI if you qualify for any other Medicaid coverage.
Qualified Disabled and Working Individual (QDWI)
QDWI is a narrower program for people with disabilities who returned to work and lost their premium-free Part A as a result. It covers Part A premiums only. The income limit is significantly higher at $5,405 per month for an individual, but the resource limit is lower at $4,000.
Income limits run slightly higher in Alaska and Hawaii, and some states set their thresholds above the federal minimums listed here.
How the Two Programs Work Together
When you have both Medicare and Medicaid, Medicare always pays first. It covers hospital stays, doctor visits, and other medical services just as it would for anyone else. Medicaid then steps in as the secondary payer, picking up costs that Medicare doesn’t fully cover.
For full dual-eligible individuals, this coordination can virtually eliminate out-of-pocket costs. Medicare handles the bulk of medical bills, and Medicaid covers the remaining deductibles, copays, and coinsurance. Medicaid may also cover services Medicare doesn’t, such as long-term nursing home care, personal care assistance, dental work, vision, hearing aids, and transportation to medical appointments. The exact additional benefits depend on your state.
For partial dual-eligible individuals (those enrolled in a Medicare Savings Program only), Medicaid’s role is more limited. It pays specific Medicare costs like premiums or cost-sharing, but doesn’t extend to additional services beyond what Medicare covers.
Prescription Drug Savings
One of the biggest financial benefits of dual eligibility is automatic enrollment in Medicare’s Extra Help program, which dramatically lowers prescription drug costs. You qualify for Extra Help automatically if you have full Medicaid coverage, receive help from a Medicare Savings Program paying your Part B premiums, or get SSI payments.
Under Extra Help in 2026, you pay no monthly premium for your Part D drug plan and no annual deductible. Your copays drop to a maximum of $5.10 for each generic drug and $12.65 for each brand-name drug. Once your total drug costs for the year reach $2,100, you pay nothing for covered prescriptions for the rest of the year. If you have both full Medicaid and QMB status, your copays are capped even lower at $4.90 per drug.
Dual Eligible Special Needs Plans
If you qualify for both programs, you may also have the option to enroll in a Dual Eligible Special Needs Plan, commonly called a D-SNP. These are Medicare Advantage plans built specifically for people with dual status. They combine your Medicare and Medicaid benefits into a single plan with one ID card and one network, which simplifies navigating two separate programs.
D-SNPs often include benefits beyond standard Medicare, such as dental, vision, hearing, meal delivery after a hospital stay, and over-the-counter health product allowances. Some D-SNPs offer zero-dollar cost sharing on Medicare services, meaning you pay nothing at the point of care. Enrollment is available to anyone with any category of dual eligibility, from QMB-only to full Medicaid. Availability and specific benefits vary by state and county.
How to Apply
There’s no single application for dual eligibility. You enroll in Medicare through the Social Security Administration, either automatically when you turn 65 (if you’re already receiving Social Security) or by applying during your initial enrollment period. Medicaid enrollment is entirely separate and handled by your state’s Medicaid office.
If you already have Medicare and think you might qualify for Medicaid, contact your state’s Medicaid agency directly. You can find your state’s office through Medicare.gov or by calling 1-800-MEDICARE. The application will ask for documentation of your income, assets, and household size. Processing times vary by state, but many states can determine MSP eligibility relatively quickly.
If you’re approved for Medicaid or a Medicare Savings Program, your dual status is established automatically. You don’t need to notify Medicare separately. The two programs coordinate behind the scenes, and your Extra Help enrollment and any billing protections take effect once your Medicaid coverage is active.
State Differences That Matter
Because Medicaid is jointly funded by the federal government and individual states, eligibility rules and benefits can differ substantially depending on where you live. States set their own income thresholds for seniors and people with disabilities, and some are considerably more generous than the federal minimums. A handful of states have eliminated or loosened asset tests entirely for certain Medicaid categories, making it easier to qualify even if you have modest savings.
The services Medicaid covers beyond Medicare also vary. Some states offer extensive home and community-based services that allow dual-eligible individuals to receive care at home rather than in a nursing facility. Others provide comprehensive dental and vision coverage. Checking with your specific state Medicaid office is the only reliable way to know exactly what you’d qualify for and what additional benefits you’d receive.