Medicaid and Medicare: How Dual Eligibility Works
Some people qualify for both Medicare and Medicaid. Learn how the two programs work together, what extra help dual eligibility can provide, and how to apply.
The short version
- People with both Medicare and Medicaid are called dual eligible.
- Medicare generally pays first, and Medicaid may cover remaining costs and extra services.
- Medicaid rules vary by state, so contact your state Medicaid office for details.
In this guide
Medicare and Medicaid are different programs. Medicare is federal health insurance for people 65 and older and some younger people with disabilities. Medicaid is a joint federal and state program that helps cover health care costs for people with limited income and resources. Some people qualify for both and are known as dual eligible.
How the programs work together
When you have both, Medicare generally pays first for services it covers. Medicaid may then pay for remaining costs, such as deductibles and coinsurance, depending on your level of eligibility.
Medicaid may also cover services that Medicare does not, such as:
- Long-term care in a nursing home
- Some home and community-based services that help people live at home
- In some states, dental, vision or transportation services
Levels of help
Some people qualify for full Medicaid benefits. Others qualify for partial help through Medicare Savings Programs, which help pay Medicare premiums and sometimes deductibles and coinsurance.
If you qualify for full Medicaid or a Medicare Savings Program, you also automatically qualify for Extra Help with Part D prescription drug costs.
Who may qualify
Medicaid eligibility depends on income, resources and other factors, and rules vary by state. Some states have programs that allow people with higher incomes to qualify if they have high medical costs, sometimes called "spend down" or medically needy programs. Long-term care Medicaid has its own rules, including how assets and transfers are evaluated.
Medicaid rules can change. For example, federal legislation enacted in 2025 added work or community engagement requirements for some adults under 65 who qualify through Medicaid expansion, with implementation dates set by law and state rules. People 65 and older are not subject to those requirements. Check with your state Medicaid office for current rules.
Dual Eligible Special Needs Plans (D-SNPs)
Some Medicare Advantage plans are designed specifically for people with both Medicare and Medicaid. These Dual Eligible Special Needs Plans coordinate benefits between the two programs and may include extra services. Availability varies by area. If you are dual eligible, you may also have more opportunities during the year to change plans. Compare carefully and check networks before enrolling.
How to apply
- Contact your state Medicaid office. You can find contact information on Medicaid.gov or by calling 1-800-MEDICARE.
- Gather documents, including identification, your Medicare card, proof of income and information about bank accounts and other resources.
- Ask for help. Your State Health Insurance Assistance Program (SHIP) and local Area Agency on Aging can explain the programs and assist with applications.
Keep your coverage active
Medicaid usually requires periodic renewal. Watch your mail for renewal notices, respond by the deadline and report changes in income, address or household. Losing Medicaid can also affect your Medicare Savings Program and Extra Help status.
Show both cards
When you get care, show both your Medicare card (or Medicare Advantage card) and your Medicaid card so providers can bill correctly. If you are in the QMB program, you generally should not be billed for Medicare cost-sharing by providers who accept Medicare.
Terrameritavi is an independent publication and is not affiliated with Medicare, Medicaid or any government agency.
