Navigating the complexities of health coverage can be overwhelming, especially for individuals with limited income or chronic health conditions. A common question many ask is: Can you have both Medicare and Medicaid at the same time? The short answer is yes—and for those who qualify, this combination can offer significant healthcare support with reduced out-of-pocket costs.
This guide provides an in-depth look at how Medicare and Medicaid can work together, who qualifies for dual eligibility, and the benefits of enrolling in both programs simultaneously.
What Is Dual Eligibility?
When someone qualifies for both Medicare and Medicaid, they are considered dual eligible. This means they can receive benefits from both programs, which coordinate to reduce healthcare costs and expand coverage.
Key Facts:
- Over 12.2 million Americans are dual eligible, according to the Kaiser Family Foundation.
- Dual eligible beneficiaries typically have lower incomes and more complex health needs.
- Medicare remains the primary payer, while Medicaid acts as a supplemental payer.
Understanding Medicare and Medicaid
What Is Medicare?
Medicare is a federal health insurance program primarily for:
- People aged 65 and older
- Younger individuals with certain disabilities
- Those with End-Stage Renal Disease (ESRD)
Parts of Medicare:
- Part A – Hospital insurance
- Part B – Outpatient/medical insurance
- Part C (Medicare Advantage) – Private plans combining Part A, B, and often D
- Part D – Prescription drug coverage
What Is Medicaid?
Medicaid is a joint federal and state program that helps cover medical costs for people with limited income and resources. Each state manages its own Medicaid program with federal guidelines.
Medicaid covers a broad range of services, including:
- Doctor visits and hospital stays
- Long-term care
- Home health services
- Dental and vision (in some states)
Types of Dual Eligibility
Dual eligible individuals fall into two categories based on their level of Medicaid assistance:
1. Full Dual Eligible
These individuals qualify for full Medicaid benefits along with Medicare. Medicaid helps pay for:
- Medicare premiums (Part A and B)
- Deductibles and coinsurance
- Long-term services and supports
- Extra benefits like transportation, dental, and vision (depending on the state)
2. Partial Dual Eligible
These individuals qualify for help with Medicare premiums and sometimes cost-sharing, but they do not receive full Medicaid services.
They may be enrolled in a Medicare Savings Program (MSP) like:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
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BOOK A CALLWhat Are the Benefits of Being Dual Eligible?
Dual eligibility provides significant cost relief and care coordination benefits.
Cost Savings
- Medicaid covers Medicare premiums: For full duals, Part B premiums (normally $174.70/month in 2025) are paid by Medicaid.
- No or low out-of-pocket expenses: Medicaid may cover deductibles, copays, and coinsurance.
Access to Additional Services
- Long-term care services (nursing home, home health)
- Vision, dental, and hearing (in some states)
- Non-emergency medical transportation
- Personal care services
Improved Health Outcomes
Studies have shown that dual eligible individuals enrolled in coordinated care models, like Dual Eligible Special Needs Plans (D-SNPs), experience:
- Fewer hospital admissions
- Lower emergency room usage
- Better chronic disease management
What Is a Dual Eligible Special Needs Plan (D-SNP)?
D-SNPs are a type of Medicare Advantage plan specifically designed for dual eligible individuals. These plans coordinate care between Medicare and Medicaid and often offer enhanced benefits.
Features of D-SNPs:
- Integrated care team
- Care coordination services
- Prescription drug coverage (Part D)
- Extra benefits (e.g., dental, OTC cards, hearing aids)
- Limited out-of-pocket costs
Stat: Over 5 million dual eligible beneficiaries are enrolled in a D-SNP as of 2024, with enrollment steadily increasing each year.
Enrollment in D-SNP:
- Must be eligible for both Medicare and Medicaid
- Can enroll during initial, annual, or special enrollment periods
How Medicare and Medicaid Work Together
Payment Coordination
Medicare pays first for covered services. Medicaid acts as the secondary payer, covering costs that Medicare does not fully pay.
For example:
- Medicare covers a hospital stay (Part A)
- Medicaid pays the deductible and copay
- Medicaid may also cover additional services not included in Medicare
Example Scenario:
Maria, age 67, has diabetes and limited income. She qualifies for Medicare based on age and Medicaid due to her financial status. Her D-SNP plan:
- Pays her Part B premium
- Covers her insulin and medications at no cost
- Provides rides to her doctor appointments
- Offers dental and vision benefits
Who Qualifies for Dual Eligibility?
Basic Eligibility:
- Must be enrolled in Medicare (Part A and/or B)
- Must meet Medicaid income and asset limits in your state
2025 General Guidelines (Varies by State):
- Income below $1,255/month (individual) or $1,704/month (couple)
- Assets under $9,430 (individual) or $14,130 (couple)
Note: Your home, one vehicle, and personal belongings are not counted as assets.
Always check with your state Medicaid office for specific guidelines.
How to Apply for Medicare and Medicaid
Step 1: Enroll in Medicare
- Apply online at SSA.gov
- Or call the Social Security Administration
Step 2: Apply for Medicaid
- Contact your state’s Medicaid agency
- Provide proof of income, assets, and Medicare enrollment
Step 3: Enroll in a D-SNP (Optional but recommended)
- Shop for plans on Medicare.gov or through a licensed insurance agent
- Look for D-SNPs with high ratings and expanded benefits in your area
Common Myths About Dual Eligibility
“I have Medicaid, so I don’t need Medicare.”
False. You need both for full coverage. Medicare covers hospital and doctor visits, while Medicaid picks up remaining costs and adds services Medicare doesn’t.
“I can’t afford Medicare premiums.”
If you’re dual eligible, Medicaid can cover your Medicare premiums.
“Applying is too complicated.”
Assistance is available. SHIP counselors and Medicaid caseworkers can walk you through each step.
Additional Support and Resources
“I have Medicaid, so I don’t need Medicare.”
False. You need both for full coverage. Medicare covers hospital and doctor visits, while Medicaid picks up remaining costs and adds services Medicare doesn’t.
“I can’t afford Medicare premiums.”
If you’re dual eligible, Medicaid can cover your Medicare premiums.
“Applying is too complicated.”
Assistance is available. SHIP counselors and Medicaid caseworkers can walk you through each step.
Additional Support and Resources
SHIP (State Health Insurance Assistance Program)
Offers free counseling to Medicare beneficiaries and helps with dual eligibility questions.
BenefitsCheckUp.org
A free screening tool from the National Council on Aging to check eligibility for Medicare, Medicaid, and other programs.
Local Medicaid Office
Your most accurate source for income limits, applications, and benefits in your state.
Final Thoughts
Being eligible for both Medicare and Medicaid can significantly reduce your healthcare expenses while offering access to more services. If you or a loved one have limited income or disabilities, dual eligibility is a critical opportunity worth exploring.
Don’t leave benefits on the table—use available programs to ensure access to high-quality, affordable care.
Wondering If You Qualify for Both Medicare and Medicaid?
Speak with a licensed advisor who can check your eligibility and walk you through your options for dual enrollment and enhanced benefits.
It takes less than 10 minutes—and could save you thousands in healthcare costs.