To qualify for both Medicare and Medicaid at the same time, you need to meet Medicare’s eligibility requirements (typically age 65 or older, or having a qualifying disability) and fall within your state’s Medicaid income and asset limits. Around 12 million Americans carry both forms of coverage, a status known as “dual eligibility.” The combination can dramatically reduce your out-of-pocket health care costs, but the path to qualifying depends on your specific financial situation and where you live.
How You Qualify for Medicare
Medicare eligibility is federal and straightforward. You qualify if you’re 65 or older and you or your spouse paid Medicare taxes for at least 10 years. You can also qualify before 65 if you’ve received Social Security Disability Insurance for 24 months, or if you have ALS (which triggers immediate Medicare eligibility upon disability approval).
End-stage renal disease is the other major pathway. If your kidneys have failed and you need regular dialysis or a kidney transplant, you can get Medicare at any age, provided you or a qualifying family member has a sufficient work history under Social Security. Coverage typically starts on the first day of the fourth month of dialysis, though it can begin sooner if you train for home dialysis or are admitted for a transplant.
How You Qualify for Medicaid
Medicaid is where things get more complicated, because each state sets its own rules. Generally, you must have limited income, limited countable assets, and be a resident of the state where you’re applying. The 40 states (plus Washington, D.C.) that expanded Medicaid under the Affordable Care Act cover adults with incomes up to 133% of the federal poverty level. The remaining states, including Texas, Florida, Georgia, Mississippi, and Kansas, have much narrower eligibility, often restricting coverage to very low-income parents, pregnant women, or people receiving Supplemental Security Income.
For older adults and people with disabilities, most states still apply an asset test alongside the income test. This means your savings, investments, and other countable resources must stay below a certain threshold. These limits vary by state.
Assets That Don’t Count
Not everything you own counts toward the asset limit. The following are typically excluded:
- Your primary home, as long as you live there
- One vehicle used for transportation
- Personal belongings and household goods, including furniture, clothing, and jewelry
- Burial spaces and up to $1,500 set aside per person for burial expenses
- Business property and tools used in a trade or self-employment
- Life insurance policies with a combined face value of $10,000 or less
- Retirement accounts that cannot be withdrawn as a lump sum
These exclusions can make a significant difference. Someone who owns a modest home and a car might assume they have too many assets, when in reality neither counts.
Full Versus Partial Dual Eligibility
Not everyone who qualifies for both programs gets the same level of coverage. Dual eligibility falls into two broad categories.
“Full-benefit” dually eligible individuals get complete Medicaid coverage on top of Medicare. This means Medicaid covers services Medicare doesn’t, like long-term care, dental, vision, and transportation in many states. It also picks up Medicare’s premiums, deductibles, and copays. To qualify, you need to meet your state’s full Medicaid eligibility requirements, which typically means very low income and assets.
“Partial-benefit” dually eligible individuals don’t qualify for full Medicaid, but they do qualify for one of the Medicare Savings Programs, which help cover specific Medicare costs. These programs have higher income limits than full Medicaid, making them accessible to more people.
Medicare Savings Programs and Their Limits
If your income is too high for full Medicaid but still limited, you may qualify for one of three main Medicare Savings Programs. Each covers a different slice of your Medicare costs. The 2026 federal limits are listed below, though some states set their thresholds slightly higher.
Qualified Medicare Beneficiary (QMB): For individuals earning up to $1,350 per month ($1,824 for couples) with resources below $9,950 ($14,910 for couples). This is the most generous partial program. Medicaid pays your Part A and Part B premiums, and Medicare providers cannot bill you for deductibles, coinsurance, or copays.
Specified Low-Income Medicare Beneficiary (SLMB): For individuals earning between $1,350 and $1,616 per month ($2,184 for couples) with the same resource limits. Medicaid pays only your Part B premium.
Qualifying Individual (QI): For individuals earning up to $1,816 per month ($2,455 for couples) with resources below $9,950 ($14,910 for couples). Like SLMB, this program covers your Part B premium only. QI funding is allocated on a first-come, first-served basis each year.
Income limits are somewhat higher in Alaska and Hawaii. And in some states, you may qualify even if your income or resources slightly exceed the federal figures, because states can apply additional disregards and deductions when calculating your eligibility.
Prescription Drug Savings
Dual eligibility automatically qualifies you for Extra Help, a federal program that slashes prescription drug costs under Medicare Part D. With Extra Help in 2026, you pay no plan premium, no deductible, and no more than $5.10 for generic drugs or $12.65 for brand-name drugs per prescription. Once your total drug costs for the year reach $2,100, you pay nothing for covered medications.
If you have full Medicaid coverage and are in the QMB program, your copays drop even further, capped at $4.90 per covered drug.
How to Apply
Medicare and Medicaid are administered by different agencies, so qualifying for both involves two separate processes. Most people already have Medicare (or are enrolled automatically at 65) before applying for Medicaid. If you already have Medicare, the next step is contacting your state Medicaid office to apply for Medicaid or a Medicare Savings Program. You’ll need to provide information about your income, assets, and residency.
You can find your state’s Medicaid office through Medicaid.gov or by calling 1-800-MEDICARE. Many states allow online applications. Social Security offices can also help you apply for the Extra Help program for prescription drugs, which may trigger a review for Medicare Savings Program eligibility.
If you’re approved for a Medicare Savings Program or full Medicaid while already on Medicare, your new benefits typically begin the month after approval. You won’t need to wait for an open enrollment period.
Switching Plans as a Dual-Eligible Individual
Starting in 2025, people with dual eligibility gained new flexibility to change their Medicare coverage. Full and partial dual-eligible individuals can now switch between standalone Part D prescription drug plans once per month, or move from a Medicare Advantage plan back to Original Medicare with a standalone drug plan once per month. Previously, these changes were more restricted.
Full-benefit dual-eligible individuals also have access to an integrated care enrollment period, which allows a once-per-month switch into specialized Medicare Advantage plans designed specifically for people with both Medicare and Medicaid. These dual special needs plans coordinate benefits across both programs, which can simplify care and reduce the administrative burden of managing two separate coverage systems.
Why State Differences Matter
Your state of residence shapes your dual eligibility more than any other single factor. In Medicaid expansion states like California, Arizona, and Arkansas, adults qualify for Medicaid at incomes up to 133% of the federal poverty level. In non-expansion states like Texas, Florida, and Georgia, childless adults often have no pathway to Medicaid regardless of how low their income is, unless they qualify through age, disability, or another categorical requirement.
For people 65 and older or those with disabilities, the picture is somewhat more uniform, since every state covers these groups through Medicaid. But the specific income thresholds, asset limits, and benefits packages still differ. Some states are more generous with income disregards, effectively raising the qualification ceiling. Others apply stricter asset tests. If you’re close to the eligibility line, the details of your state’s rules will determine the outcome, so checking directly with your state Medicaid office is the most reliable way to find out where you stand.