A dual eligible is someone who qualifies for both Medicare and Medicaid at the same time. About 11.8 million people fall into this category, roughly 19% of all Medicare beneficiaries. Because these two programs overlap, dual eligibles receive more comprehensive coverage than either program provides alone, with Medicaid picking up many of the costs that Medicare leaves behind.
How Someone Becomes Dual Eligible
Medicare covers people 65 and older, along with younger adults who have certain disabilities. Medicaid covers people with low incomes. When someone meets the requirements for both, they’re considered dually eligible. This typically happens in two scenarios: an older adult on Medicare whose income is low enough to also qualify for Medicaid, or a younger person with a disability who qualifies for Medicare through Social Security and for Medicaid through limited income.
There’s no single “dual eligible” application. You qualify for Medicare through the federal government (usually automatically at 65 or after receiving disability benefits for two years), and you apply for Medicaid through your state. When your state determines you meet Medicaid’s criteria while you’re already on Medicare, you become a dual eligible.
Full Dual Eligibles vs. Partial Dual Eligibles
Not all dual eligibles receive the same level of help. The distinction comes down to whether you qualify for full Medicaid benefits or only for a Medicare Savings Program that covers specific Medicare costs.
Full dual eligibles receive the complete package: all of Medicare’s benefits plus all of their state’s Medicaid benefits. Medicaid pays their Medicare Part B premium, covers their share of Medicare deductibles, coinsurance, and copayments, and provides additional services Medicare doesn’t cover, like long-term care, dental, or transportation to appointments.
Partial dual eligibles qualify for one of four Medicare Savings Programs, each with different income thresholds and different levels of help:
- Qualified Medicare Beneficiaries (QMB): For people with income up to 100% of the federal poverty level. Medicaid pays Medicare Part A and Part B premiums, plus deductibles, coinsurance, and copayments. Providers cannot bill QMB beneficiaries for Medicare cost-sharing.
- Specified Low-Income Medicare Beneficiaries (SLMB): For people with income between 100% and 120% of the federal poverty level. Medicaid pays the Part B premium only.
- Qualifying Individuals (QI): For people with income between 120% and 135% of the federal poverty level. Medicaid pays the Part B premium, subject to available funding in the state.
- Qualified Disabled and Working Individuals (QDWI): For people who lost free Medicare Part A coverage after returning to work from disability. Income must be below 200% of the federal poverty level. Medicaid pays only the Part A premium.
Income and Asset Limits
For QMB and SLMB, the asset limit is $9,950 for an individual and $14,910 for a couple. These figures exclude your home, one vehicle, and burial funds. For 2026, the monthly income limit for QMB is $1,350 for an individual and $1,824 for a couple in most states (higher in Alaska and Hawaii). The SLMB monthly income limit is $1,616 for an individual and $2,184 for a couple. These thresholds shift slightly each year as the federal poverty level is updated.
Full Medicaid eligibility varies more widely because each state sets its own income and asset rules. Some states have expanded Medicaid to cover adults earning up to 138% of the federal poverty level, while others use stricter thresholds.
How the Two Programs Work Together
When you have both Medicare and Medicaid, Medicare is the primary payer. It processes and pays claims first. Medicaid then acts as the secondary payer, covering remaining costs that fall within its scope. For a full dual eligible, this means you rarely pay anything out of pocket for covered services. Medicare handles hospital stays, doctor visits, and outpatient care. Medicaid fills the gaps: long-term nursing home care, personal care services, home health aides, and benefits that vary by state like dental, vision, and hearing.
This layered coverage matters because Medicare has significant cost-sharing. A standard Medicare beneficiary pays a roughly $1,600 deductible for each hospital stay, 20% coinsurance on most outpatient services, and a monthly Part B premium. For someone living near the poverty line, those costs are unmanageable. Medicaid eliminates or dramatically reduces them.
Prescription Drug Coverage and Extra Help
Dual eligibles automatically qualify for Medicare’s Extra Help program (also called the Low-Income Subsidy), which slashes prescription drug costs. In 2025, Extra Help covers the full drug plan premium and deductible. You pay no more than $4.90 for each generic drug and $12.15 for each brand-name drug. Once your total out-of-pocket drug spending reaches $2,000, you pay nothing for covered prescriptions for the rest of the year.
You don’t need to apply separately for Extra Help if you already have both Medicare and Medicaid, are in a Medicare Savings Program, or receive Supplemental Security Income. The enrollment is automatic.
Health Needs of the Dual Eligible Population
Dual eligibles tend to have more complex health needs than the average Medicare beneficiary. They are more likely to live with multiple chronic conditions, and more than twice as likely to have difficulty with basic daily activities. Among dual eligibles living in the community, 55% have difficulty bathing or showering, 42% have trouble getting in and out of bed or chairs, 40% have difficulty dressing, and 36% struggle with walking.
This profile explains why dual eligibles account for a disproportionate share of both Medicare and Medicaid spending. They use more hospital care, more home health services, and more long-term care than people enrolled in just one program. It also explains why coordinating their care across two separate systems, each with its own rules and provider networks, has been a persistent challenge.
Dual Eligible Special Needs Plans
To address the coordination problem, Medicare offers a type of managed care plan designed specifically for this population: Dual Eligible Special Needs Plans, or D-SNPs. These are Medicare Advantage plans that only enroll people who have both Medicare and Medicaid. The goal is to bring both programs’ benefits under one plan with one ID card, one provider network, and one care coordination team.
D-SNPs typically include extras not found in original Medicare, such as dental coverage, vision benefits, over-the-counter health product allowances, and transportation to medical appointments. The level of integration with Medicaid varies by state. Some D-SNPs closely coordinate with the state Medicaid program so that all of your benefits flow through a single plan. Others handle only the Medicare side, leaving Medicaid benefits separate. Enrollment in a D-SNP is voluntary.
How to Apply
If you already have Medicare and think you might qualify for Medicaid or a Medicare Savings Program, you apply through your state Medicaid office. Each state runs its own program and determines which category you qualify for based on your income, assets, and living situation. You can find your state’s Medicaid agency through Medicare.gov or by calling 1-800-MEDICARE. Many states allow online applications, and local State Health Insurance Assistance Programs (SHIPs) offer free counseling to help you through the process.