To qualify for both Medicare and Medicaid at the same time, you need to meet Medicare’s age or disability requirements and fall within your state’s income and resource limits for Medicaid. About 12 million Americans carry both forms of coverage, and they’re known as “dual-eligible” beneficiaries. The path to qualifying depends on whether you’re seeking full Medicaid benefits or partial help with your Medicare costs.
How Medicare Eligibility Works
Medicare is the federal health insurance program, and qualifying for it is the first half of the equation. Most people become eligible at age 65, as long as they (or a spouse) paid Medicare taxes for at least 10 years of work. Age alone qualifies you regardless of income.
If you’re under 65, you can qualify for Medicare after receiving Social Security Disability Insurance (SSDI) benefits for 24 consecutive months. There’s one exception to that waiting period: people diagnosed with ALS (Lou Gehrig’s disease) get Medicare as soon as their disability benefits begin. People with end-stage kidney disease also qualify regardless of age.
How Medicaid Eligibility Works
Medicaid is jointly run by the federal government and your state, so income and resource limits vary depending on where you live. For people 65 and older or those with a disability, eligibility is generally tied to the income thresholds used by the Supplemental Security Income (SSI) program. You typically need both low income and limited countable assets to qualify for full Medicaid benefits.
Not everything you own counts toward the asset limit. Your primary home, your main vehicle, household furnishings, and retirement accounts you’re actively drawing from are all excluded. What does count: cash, bank accounts, second homes, and additional vehicles. If you live in a nursing home but plan to return to your house, or if your spouse or a dependent relative still lives there, the home remains excluded.
Some states also offer “medically needy” or spenddown programs for people whose income is slightly too high. In these programs, your medical expenses are subtracted from your income, and if the remainder falls below the threshold, you qualify. Thirty-six states and the District of Columbia offer some form of spenddown pathway.
Full Dual Eligibility vs. Partial
Not all dual-eligible beneficiaries receive the same level of coverage. The distinction matters because it determines what Medicaid actually pays for.
“Full” dual eligibles qualify for their state’s complete Medicaid benefits package on top of Medicare. This typically includes long-term care, dental, vision, hearing, and transportation that Medicare doesn’t cover. To get full dual eligibility, you must meet your state’s standard Medicaid income and resource requirements.
“Partial” dual eligibles qualify for help with their Medicare premiums and cost-sharing through Medicare Savings Programs, but they don’t receive the full range of Medicaid services. About 29 percent of all dual-eligible beneficiaries fall into this partial category. If your income is too high for full Medicaid but still relatively low, a Medicare Savings Program may be your path to some level of dual coverage.
Medicare Savings Programs and Their Income Limits
Medicare Savings Programs (MSPs) use Medicaid funds to help low-income Medicare beneficiaries afford their premiums, deductibles, and copays. There are four tiers, each with different income thresholds and benefits. All resource limits for 2026 are $9,950 for an individual and $14,910 for a married couple (except for the QDWI program).
- Qualified Medicare Beneficiary (QMB): Covers Part A and Part B premiums, deductibles, coinsurance, and copays. Income limit: $1,350/month for an individual, $1,824 for a married couple.
- Specified Low-Income Medicare Beneficiary (SLMB): Covers only the Part B premium. Income limit: $1,616/month individual, $2,184 married.
- Qualifying Individual (QI): Also covers the Part B premium, but you must reapply each year. Income limit: $1,816/month individual, $2,455 married.
- Qualified Disabled and Working Individuals (QDWI): Helps certain working adults under 65 with disabilities pay their Part A premium. Income limit: $5,405/month individual, $7,299 married. Resource limits are lower for this program, at $4,000 individual and $6,000 for couples.
These are federal minimums. Some states set their income or asset limits higher, so you may qualify even if you’re slightly above the numbers listed here. Limits are also higher in Alaska and Hawaii.
Prescription Drug Help for Dual Eligibles
If you qualify for both Medicare and full Medicaid, you automatically receive Extra Help (also called the Low-Income Subsidy) with your Medicare Part D prescription drug costs. This benefit dramatically reduces what you pay at the pharmacy, covering most or all of your premiums, deductibles, and copays for medications.
Even if you don’t qualify for full Medicaid, you can apply for Extra Help separately through Social Security. The 2026 income limits for Extra Help are $23,475 per year for an individual and $31,725 for a married couple, with resource limits of $18,090 and $36,100 respectively. When you apply for Extra Help, Social Security can also forward your information to your state Medicaid office to start a Medicare Savings Program application at the same time.
Dual Eligible Special Needs Plans
Once you have both Medicare and Medicaid, you may be able to enroll in a Dual Eligible Special Needs Plan (D-SNP). These are a type of Medicare Advantage plan designed specifically for people with both programs. D-SNPs coordinate your Medicare and Medicaid benefits under one plan, which simplifies things considerably since you’re dealing with one card and one set of providers instead of navigating two separate systems. Some D-SNPs offer zero-dollar cost sharing for Medicare-covered services, meaning no copays or coinsurance at the point of care.
How to Apply
Medicare enrollment happens through Social Security, either automatically when you turn 65 (if you’re already receiving Social Security benefits) or through an application at ssa.gov or your local Social Security office. If you qualify through disability, Medicare begins automatically after your 24-month SSDI waiting period.
Medicaid applications go through your state’s Medicaid agency, not through the federal government. You can typically apply online, by phone, by mail, or in person at a local office. Each state has its own application process and its own name for the program (Medi-Cal in California, MassHealth in Massachusetts, and so on). You’ll need to provide documentation of your income, assets, residency, and citizenship or immigration status.
For Medicare Savings Programs specifically, you apply through your state Medicaid office. If you’re already receiving SSI benefits in most states, you’re automatically enrolled in Medicaid without a separate application. The process can take several weeks, and eligibility is often reviewed annually, so keeping your contact information and financial records current with your state agency helps avoid gaps in coverage.