Medicare is the federal health insurance program in the United States for people ages 65 and older. Medicaid is a joint federal and state program to help people with limited resources or income pay for medical costs. You may qualify for both.
According to Health Affairs, more than 12 million people, about 3% of the United States population, are enrolled in both Medicare and Medicaid.
Keep reading to learn more about dual eligibility, benefits, and state-by-state differences.
Medicare vs. Medicaid
The terms Medicaid and Medicare are often confused since they are both government healthcare programs.
Medicare: This is a government-funded medical insurance option that many older Americans use as their primary health insurance. It also covers people with certain disabilities and health conditions. Medicare is not free coverage — you’ll still pay deductibles, premiums, and copays for medical services.
Medicaid: This is a program that combines the efforts of the U.S. state and federal governments to assist households in low-income groups with healthcare expenses. These may include major hospitalizations and treatments as well as routine medical care. This care is often provided at low or no cost, depending on income. Medicaid also offers benefits not typically covered by Medicare.
If you’re eligible for both Medicare and Medicaid, you’re considered a dual eligible beneficiary. Your age, any disabilities, and income typically determine dual eligibility.
Generally, people who qualify for both programs may be older adults over the age of 65 who are generally healthy but have limited financial means. Others may have had more wealth at one point but depleted their resources due to healthcare or long-term care expenses. Dual enrollees can also include people living with disabilities who have difficulty finding and maintaining employment, as well as people under the age of 65 who left the workforce due to significant physical or mental impairments.
For dual-eligible beneficiaries, Medicare is typically the primary payer, while Medicaid covers costs that Medicare may not fully cover, such as home-based services, personal care, and nursing home care. Other coverage options like employer group health plans or Medigap may also come into play.
There are a few ways you could qualify for dual eligibility. You may have enrolled in one program before becoming eligible for the other or vice versa:
- Qualified Medicare Beneficiary (QMB) without other Medicaid coverage: If your income is below 100% of the federal poverty level (FPL) and your resources are under three times the limit for supplementary security income eligibility, Medicaid will cover your Medicare Part A and B premiums. This status also applies to those with limited Part B Immunosuppressive Drug benefits.
- QMB “full-benefit”: In this case, you meet the requirements for both QMB and another eligibility group, giving you all benefits from both programs.
- Specified Low-Income Medicare Beneficiaries (SLMBs): If you don’t have any other Medicaid assistance (also called SLMB “partial-benefit”), you’re eligible for Medicare Part A coverage if your income is between 100% and 120% of the FPL, and your resources fall below three times the limit for receiving supplementary security income (SSI). Medicaid will cover your Part B premium.
- Qualifying Individuals (QIs): You’re eligible for Part A coverage and must have a minimum income of 120% but less than 135% of the FPL. Your resources can’t exceed three times the limit for SSI eligibility, adjusted for inflation. If you don’t qualify for any other Medicaid program, you can receive help with your Medicare Part B premiums through available slots funded by the federal government.
- Qualified Disabled and Working Individuals (QDWIs): You receive premium-free Part A Medicare coverage based on your eligibility for Social Security Disability Insurance (SSDI). But if you return to work and lose your benefits, you may also lose your premium-free Medicare Part A. Your income can’t exceed 200% of the FPL, and your resources have to be within two times the SSI resource standard. If you don’t also qualify for Medicaid, it will cover only your Medicare Part A premium.
- Full-benefit Medicaid: You’re entitled to Medicare Part A and/or Part B, as well as full Medicaid benefits. For services that are covered by both Medicare and Medicaid, you won’t pay any additional coinsurance. If the service is only covered by Medicare, you may need to pay cost-sharing unless their state chooses to cover it for this group.
Note that your exact benefits for dually eligible beneficiaries can differ based on your state of residence. Differences by state may include:
- Medicaid offered through Medicaid-managed care plans
- fee-for-service Medicaid coverage
- plans that include all Medicare and Medicaid benefits
Federal law defines income and resource standards for full Medicaid and Medicare Savings Programs (MSP). States can raise the federally mandated limits at their discretion.
You’re also considered a dual eligible beneficiary if you’re enrolled in Medicare Part A or Part B and receiving cost-sharing through an MSP.
Below is a table summarizing the benefits and eligibility criteria for each of the different MSPs in 2024:
| MSP | Benefits | Eligibility |
|---|---|---|
| Qualified Disabled Working Individual (QDWI) program | pays the Part A premium for certain beneficiaries who are working and have certain disabilities | Individual Income: $5,302 Assets:$4,000 Married Income: $7,135 Assets:$6,000 |
| Qualifying Individual (QI) program | assists in the payment of Part B premiums | Individual Income: $1,781 Assets: $9,660 Married Income: $2,400 Assets: $14,470 |
| Qualified Medicare Beneficiary (QMB) program | assists in the payment of deductibles, premiums, coinsurance, and copayments for Part A, Part B, or both | Individual Income: $1,325 or less Assets: $9,660; Married Income: $1,783 or less, Assets: $14,470 |
| Specified Low-Income Medicare Beneficiary (SLMB) program | assists in the payment of Part B premiums | Individual Income: $1,585 Assets: $9,660 Married Income: $2,135 Assets: $14,470 |
In addition to the Medicare savings programs, you also may be eligible for some of the following needs-based programs through Medicare:
- PACE (Program of All-inclusive Care for the Elderly): This is a Medicare-Medicaid joint program that provides medical and social services for people with significant needs who want to continue living at home
- Medicare’s Extra Help program: This program helps those with low incomes get the prescription drugs they need at reduced or no cost
Can I keep my Medicaid when I get Medicare?
Enrolling in Medicare doesn’t mean you will lose your Medicaid coverage. As long as you still meet the qualifications for Medicaid in your state, you will continue to receive both types of coverage even after enrolling in Medicare.
How do I apply for dual Medicare and Medicaid?
To get both Medicare and Medicaid, you have to meet the criteria for both programs. To find out whether you’re eligible and learn how to enroll, you can apply for Medicare online and on the website of your state’s agency for Medicaid.
What is the highest income to be eligible for Medicaid?
The FPL for qualifying for Medicaid is different for every state. These limits for 2025 are listed by the U.S. Department of Health and Human Services (HHS).
Dual eligibility for Medicare and Medicaid means that you’re enrolled in Medicare and either:
- receiving full Medicaid benefits
- receiving assistance with Medicare Premiums through MSP
- receiving cost-sharing through Medicare needs-based programs such as PACE and ExtraHelp
If you’re a dual eligibility beneficiary, it’s likely that most of your healthcare costs are covered.
