Who Is Eligible for Both Medicare and Medicaid?
HSChange Editorial Team
Health Policy Research Team, Consumer Health Guidance
Reviewed by Dr. Sarah Mitchell, MD, MPH, Board-Certified Internal Medicine
Last updated: April 4, 2026
About 12 million Americans are enrolled in both Medicare and Medicaid at the same time. They're called "dual eligibles" or "dually eligible individuals." These are typically low-income seniors or younger people with disabilities who qualify for Medicare based on age or disability and for Medicaid based on income.
Who Qualifies
You may be dual eligible if you're 65 or older (or have a qualifying disability) and have limited income and assets. Medicaid eligibility varies by state, but most dual eligibles fall into categories like: SSI recipients (automatically eligible for Medicaid in most states), low-income Medicare beneficiaries who qualify for a Medicare Savings Program, or people in nursing homes whose income goes toward care costs.
How the Two Programs Work Together
Medicare is the primary payer. It covers hospital stays, doctor visits, and other standard Medicare benefits first. Medicaid then fills the gaps. Depending on your level of dual eligibility, Medicaid may pay your Medicare premiums, deductibles, and copays. It may also cover services Medicare doesn't, including long-term care, dental, vision, hearing, and transportation.
Medicare Savings Programs
Even if you don't qualify for full Medicaid, you may qualify for a Medicare Savings Program (MSP) that helps pay Medicare costs. The Qualified Medicare Beneficiary (QMB) program pays your Part A and Part B premiums plus deductibles and coinsurance. The Specified Low-Income Medicare Beneficiary (SLMB) program pays your Part B premium. The Qualifying Individual (QI) program also pays the Part B premium for people with slightly higher income. Contact your state Medicaid office to apply.
Dual Eligible Special Needs Plans
If you're dual eligible, you can enroll in a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed specifically for people on both programs. D-SNPs coordinate your Medicare and Medicaid benefits in one plan, which can simplify care management. You can enroll in or switch D-SNPs every quarter.