Help with costs

Dual eligibility: Medicare and Medicaid

Being "dual eligible" means you qualify for both Medicare and Medicaid. Medicare stays your primary coverage, and Medicaid helps pay your Medicare costs and covers services Medicare doesn’t — like long-term care. Full duals get full Medicaid; partial duals get help with Medicare costs through a Savings Program. Out-of-pocket costs are very low.

Reviewed by Scott Stafford, Licensed Insurance Agent

Last updated

What dual eligibility means

Dual eligibility simply means you qualify for both programs at once: Medicare, which you earn through age or disability, and Medicaid, which is based on limited income and resources. Together they form some of the most complete coverage available, because each one fills gaps the other leaves.

Full versus partial duals

There are two broad groups. Full duals qualify for full Medicaid, which pays their Medicare premiums and cost-sharing and also covers services Medicare doesn’t — most importantly long-term care in a nursing home or at home. Partial duals don’t get full Medicaid but qualify for a Medicare Savings Program that helps with their Medicare costs. Which group you fall into depends on your income and your state’s rules.

How the two coordinate

The order is consistent: Medicare pays first as your primary coverage, and Medicaid pays second, picking up cost-sharing and covering extra services. For full duals, the result is very little or nothing out of pocket for covered care. You generally don’t have to coordinate the two yourself — they’re designed to work in sequence.

Plans built for duals

Many dual-eligible people enroll in a Dual-Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan designed specifically for this group. A D-SNP coordinates your Medicare and Medicaid benefits in one place and often adds extra benefits and dedicated care coordination, which can make a complex situation much simpler to manage.

If your circumstances change and you gain or lose Medicaid, you get a Special Enrollment Period to adjust your Medicare coverage to match.

Common questions

Dual eligibility: Medicare and Medicaid FAQ

Who is dual eligible?
Anyone who qualifies for both Medicare and Medicaid. Full duals have full Medicaid; partial duals qualify for a Medicare Savings Program that helps with Medicare costs.
What does Medicaid cover that Medicare doesn’t?
Most notably long-term care — extended nursing-home stays or in-home care — which Medicare generally doesn’t cover. For full duals, Medicaid also pays Medicare premiums and cost-sharing.
What is a D-SNP?
A Dual-Eligible Special Needs Plan is a Medicare Advantage plan built for people with both Medicare and Medicaid. It coordinates the two programs and often adds extra benefits and care coordination.

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