Medicare and Medicaid are different government-funded healthcare programs. To be eligible for both, a person must qualify for either partial-dual or full-dual coverage.
Both Medicare and Medicaid help people pay for healthcare costs. If a person qualifies for both, the government refers to them as dually eligible. Around 12 million people in the United States are dually eligible for Medicare and Medicaid.
This article explains dual eligibility for Medicare and Medicaid, including who is eligible and what to know about each program.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Dual-eligible beneficiaries are people who have both Medicare and Medicaid.
In most cases, anyone 65 years of age or older can qualify for Medicare, or if they are younger but receive disability benefits or have specific medical conditions.
Meanwhile, eligibility for Medicaid depends on the region where a person lives and on their income. Therefore, a person can qualify for both Medicare and Medicaid through either partial-dual or full-dual coverage if they fulfill the eligibility criteria of both programs in different ways.
According to a 2020 data analysis brief, 37.9% of dual-eligible beneficiaries met Medicare requirements based on a disability in 2019.
Eligibility for Medicaid is typically determined by the federal poverty level (FPL), but it differs depending on the state and the specific eligibility group.
There is an FPL for the 48 contiguous states and the District of Columbia, with a higher FPL in Alaska and Hawaii. The FPL varies according to a family’s size.
Generally, individuals qualify for Medicaid if their income is below 133% of the FPL. However, certain groups, like children eligible for the Children’s Health Insurance Program (CHIP), may qualify if their parents’ income reaches up to 375% of the FPL in certain states.
That said, according to federal law, some groups, such as people receiving Supplemental Security Income (SSI), qualified pregnant people, or families with a low income, are automatically eligible.
Additional dual-eligible Medicare-Medicaid income limits
A person can also qualify for both Medicare and Medicaid based on enrolling in one of Medicare savings programs (MSPs):
The table below outlines the income thresholds for eligibility for these various MSPs in 2025:
| MSP | Eligibility |
|---|---|
| QDWI | Individual • Income: $5,302 • Assets: $4,000 Married • Income: $7,135 • Assets: $6,000 |
| QI | Individual • Income: $1,781 • Assets: $9,660 Married • Income: $2,400 • Assets: $14,470 |
| QMB | Individual • Income: $1,325 or less • Assets: $9,660 Married • Income: $1,783 or less • Assets: $14,470 |
| SLMB | Individual • Income: $1,585 • Assets: $9,660 Married • Income: $2,135 • Assets: $14,470 |
A person will not lose their Medicaid coverage if they are eligible for Medicare. Those who qualify for full coverage under both programs may receive all the benefits for which partial-dual enrollees qualify, plus additional benefits, such as long-term care services.
The extent of the coverage, however, depends on the support that a person receives from Medicaid. Examples of the varied coverage may include:
- Part A premium (if applicable)
- Part B premium
- coinsurances
- copayments
- deductibles
How do I apply for dual Medicare and Medicaid?
To qualify for both Medicare and Medicaid, you must meet each program’s specific criteria. To determine your eligibility and understand the enrollment process, you can apply for Medicare online and visit your state’s Medicaid agency website.
Each state is responsible for determining Medicaid coverage, and, as such, Medicaid benefits may vary.
That said, receiving both Medicare and Medicaid can help decrease healthcare costs for those who often need treatment the most. As a general rule, Medicare usually pays first for health services, and Medicaid covers any differences up to its payment limits.
On average, however, Medicare spends
A person may qualify for both Medicare and Medicaid based on their health and income level.
If a person is dual-eligible, Medicare will usually pay for health expenses first, and Medicaid may help pay for out-of-pocket and non-covered expenses.
Medicaid coverage varies depending on each state’s rules and income level requirements.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
“”””