What is a dual eligible?

Someone who qualifies for both Medicare and Medicaid. Medicare pays first for covered services; Medicaid often picks up Medicare's deductibles, coinsurance, and premiums, plus services Medicare doesn't cover, like long-term care and dental.

A Dual Eligible Special Needs Plan — a type of Medicare Advantage plan designed for people on both programs. D-SNPs coordinate Medicare and Medicaid benefits under one card and often include extra benefits and zero-dollar cost-sharing for many services.

Qualified Medicare Beneficiary, a Medicare Savings Program that pays your Part B premium and protects you from being billed for Medicare cost-sharing. Providers who accept Medicare must accept Medicare's payment and Medicaid's payment as payment in full.

Can Medicaid pay my Medicare premium?

Yes. Medicare Savings Programs (QMB, SLMB, QI, QDWI) pay Part B premiums for people who qualify by income. QMB also pays Part A premiums if you have to pay one, plus Medicare deductibles and coinsurance.

Does Medicaid cover long-term care?

Yes. Medicaid is the largest payer of long-term custodial care in nursing homes and through home and community-based waivers. Medicare does not cover long-term custodial care. The two programs together fill very different gaps.

Medicare and Medicaid together

If you qualify for both programs, you have access to coverage that almost nobody else gets. We see people miss out on it because nobody explained the rules.

The short version

People who qualify for both Medicare and Medicaid are called dual eligibles. Medicare pays first. Medicaid covers what Medicare doesn't: long-term care, most cost-sharing, and often Part B premiums through Medicare Savings Programs. D-SNPs bundle both under one Medicare Advantage plan.

How costs work for dual eligibles

When you have both, Medicare bills first. The provider then bills Medicaid for what Medicare didn't pay, up to Medicaid's allowed amount. You usually owe nothing at the point of care.

For prescriptions, dual eligibles automatically get Extra Help, which dramatically reduces Part D copays. Many dual eligibles pay $0 to a few dollars per prescription.

Medicare Savings Programs (MSPs)

Four MSPs, in order of how much help they provide:

QMB — Qualified Medicare Beneficiary: pays Part A and B premiums, deductibles, coinsurance, and copays. Providers can't balance-bill you.
SLMB — Specified Low-Income Medicare Beneficiary: pays the Part B premium only.
QI — Qualifying Individual: pays the Part B premium only. First-come, first-served; reapply each year.
QDWI — Qualified Disabled and Working Individual: pays the Part A premium for disabled workers who lost premium-free Part A by returning to work.

Income and asset limits vary by state. Some states have higher limits or no asset test. Apply through your state Medicaid office, not Social Security.

D-SNPs: Dual Eligible Special Needs Plans

D-SNPs are Medicare Advantage plans built for dual eligibles. They coordinate both programs under one plan, often include zero-dollar premiums and cost-sharing, and add benefits like dental, vision, hearing, and over-the-counter allowances.

Not every D-SNP is the same. Coordination-only plans (CO-D-SNPs) handle just Medicare and pass Medicaid claims through to your state. Fully integrated plans (FIDE-SNPs and HIDE-SNPs) manage both. The integrated plans usually feel smoother to use.

Long-term care

Medicare does not cover long-term custodial care. Medicaid does — in nursing homes and increasingly through home and community-based services (HCBS) waivers that let people stay in their homes.

Qualifying for long-term care Medicaid has separate income and asset rules from MSP qualification. Many people qualify for long-term care Medicaid through medical-needs pathways even when their income exceeds standard limits.

Switching D-SNPs more often

Dual eligibles get a quarterly Special Enrollment Period in three of the first four quarters. You can change D-SNPs once per quarter from January through September. This gives you more flexibility than non-dual Medicare beneficiaries.

Frequently asked questions

What is a dual eligible?: Someone who qualifies for both Medicare and Medicaid. Medicare pays first for covered services; Medicaid often picks up Medicare's deductibles, coinsurance, and premiums, plus services Medicare doesn't cover, like long-term care and dental.
What is a D-SNP?: A Dual Eligible Special Needs Plan — a type of Medicare Advantage plan designed for people on both programs. D-SNPs coordinate Medicare and Medicaid benefits under one card and often include extra benefits and zero-dollar cost-sharing for many services.
What is QMB?: Qualified Medicare Beneficiary, a Medicare Savings Program that pays your Part B premium and protects you from being billed for Medicare cost-sharing. Providers who accept Medicare must accept Medicare's payment and Medicaid's payment as payment in full.
Can Medicaid pay my Medicare premium?: Yes. Medicare Savings Programs (QMB, SLMB, QI, QDWI) pay Part B premiums for people who qualify by income. QMB also pays Part A premiums if you have to pay one, plus Medicare deductibles and coinsurance.
Does Medicaid cover long-term care?: Yes. Medicaid is the largest payer of long-term custodial care in nursing homes and through home and community-based waivers. Medicare does not cover long-term custodial care. The two programs together fill very different gaps.

See whether you qualify for Medicaid help

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Educational resource. Not legal, tax, or insurance advice.