If you’re over 65, you qualify for Medicare, a federally funded program that also covers those under 65 with certain disabilities. Medicaid is a state-administered federal health insurance program for low-income individuals.
For the millions of people who qualify for both programs, Medicaid offers critical support for Medicare beneficiaries with limited incomes, helping to ease the financial burden of health care costs.
Knowing how these programs work together, and how recent updates may affect you, is key to understanding dual eligibility and your coverage options.
[READ: Medicare vs. Medicare Advantage: How to Choose.]
Differences Between Full Dual and Part Dual
Approximately 13 million people are enrolled in both Medicare and Medicaid, according to a 2025 study in Medical Care Research and Review.
There are two main types of these dual-eligible beneficiaries:
— Full-benefit beneficiaries. These beneficiaries are eligible for Medicaid coverage for health care services that Medicare does not cover. They also receive coverage for premiums, deductibles, copays and coinsurance.
— Partial-benefit beneficiaries. These beneficiaries are eligible for Medicaid but receive restricted benefits, often to cover specific costs, which may include Medicare Part A or Part B premiums, deductibles and copayments.
KFF reports that nearly three-quarters of dual eligibles are full-benefit enrollees who receive comprehensive Medicaid services, including long-term care, which Medicare doesn’t cover. The remaining partial-benefit enrollees receive assistance primarily for Medicare premiums and cost-sharing.
Despite representing a small portion of overall beneficiaries, dual eligible individuals account for a disproportionate share of both Medicare and Medicaid spending, with an estimated 33% of traditional Medicare and 32% of Medicaid expenditures, KFF notes.
[SEE: Preventing Costly Medicare Mistakes: Tips and Strategies]
How to Qualify for Dual Eligibility
Medicare and Medicaid eligibility are handled and determined separately. The general process for applying for both, however, involves the following steps.
Step 1: Enroll in Medicare
Most beneficiaries sign up for Medicare during the initial enrollment period, which starts three months before their 65th birthday and ends three months afterward.
You may also qualify to receive Medicare benefits regardless of age if:
— You have a disability that prevents you from working and you are receiving Social Security disability benefits
— You live with end-stage renal disease
— You have amyotrophic lateral sclerosis
When the time comes to apply for Medicare, you can:
— Enroll online through the Social Security Administration’s website
— Call the SSA at 1-800-772-1213
— Visit a local Social Security office in person. The Social Security website has a “Find an Office” tool that will help you locate the nearest one.
Step 2: Apply for Medicaid through your state
Applying for Medicaid involves determining eligibility
and submitting an application through your state’s Medicaid office. Since each state manages its own Medicaid programs, rules and requirements vary. Use tools like the Medicaid eligibility checker on HealthCare.gov or your state’s Medicaid website to see if you qualify.
Medicare beneficiaries can become eligible for Medicaid if they meet specific income and asset requirements set by their state:
— Income limits. To qualify for Medicaid, beneficiaries must have income that is below a certain level (which varies by state). Generally, individuals must have an income at or below 100% to 138% of the federal poverty level to qualify.
— Asset limits. Medicaid also considers assets, or “resources,” which may include savings, property and investments. The asset limits are typically lower than the income limits. For example, in many states, individuals must have assets below $2,000 for an individual or $3,000 for a couple, though some states may allow higher limits or exclude certain assets, such as a primary home.
— Level of need. Some Medicaid benefits, like long-term care or home- and community-based services, may require an assessment of functional limitations or medical necessity.
“I strongly encourage people to plan ahead for long-term care and not wait until they run out of money in retirement and then apply for Medicaid,” says Kenton Johnston, associate professor of medicine at Washington University in St. Louis School of Medicine. “Most states have very strict income and asset limit requirements in place that prevent people from using Medicaid instead of their own assets to cover long-term care, including preventing them from transferring those assets to family members and then applying.”
Depending on income levels, you may qualify for Medicare Savings Programs that assist with Medicare expenses, such as premiums, deductibles and copayments.
These programs include:
— Qualified Medicare Beneficiary (QMB) program. For individuals with incomes at or below 100% of the federal poverty level, QMB helps cover Medicare premiums, deductibles, coinsurance and copayments.
— Specified Low-Income Medicare Beneficiary (SLMB) program. For individuals with incomes between 100% and 120% of the federal poverty level, SLMB pays for Medicare Part B premiums.
— Qualifying Individual (QI) program. For individuals with incomes between 120% and 135% of the federal poverty level, QI pays for Medicare Part B premiums, but funding is limited and provided on a first-come, first-served basis.
— Qualified Disabled and Working Individual (QDWI) program. For certain disabled individuals with incomes up to 200% of the federal poverty level, QDWI covers Medicare Part A premiums.
Step 3: Choose your plan
After being approved for Medicaid, you are automatically considered “dual eligible,” and there is not a separate third application to tie the two programs together. You can stay on original Medicare (Part A and Part B), with Medicaid helping to pay costs, or you can choose to enroll in a dual-eligible Special Needs Plan (D-SNP), a specialized type of Medicare Advantage plan designed exclusively for people who qualify for both Medicare and Medicaid.
Keep in mind that state-specific approaches mean that dual-eligible beneficiaries can have very different experiences depending on where they live. In New York, for instance, access to integrated coverage often depends on county-level programs like IB-Dual or Medicaid Advantage Plus, so some beneficiaries may have multiple plan choices, while others must manage Medicare and Medicaid separately. In California, the statewide expansion of Medi-Medi Plans means more dual eligibles can enroll in a single coordinated plan that manages both Medicare and Medi-Cal benefits under one insurer.
[READ: What Is the Medicaid Spend Down? Everything You Need to Know]
Strengthening Dual Eligibility Coverage in 2026
Navigating the Medicare and Medicaid landscape can be particularly difficult for beneficiaries who qualify for both.
“Dual-eligible beneficiaries have dealt with a highly complex system, with Medicare covering medical and pharmacy needs, while Medicaid addresses costs, like premiums, copays and long-term care,” says Eric Roberts, an associate professor at the University of Pennsylvania’s Perelman School of Medicine and a senior fellow at the Leonard Davis Institute of Health Economics. “This intricate overlap has historically created challenges in coordinating care, ensuring coverage and managing costs for a vulnerable population with significant health and financial needs.”
Recent policy changes, however, aim to streamline the program and make it easier for individuals to better understand how to access their benefits.
Integrated D-SNPs: The new standard for dual coverage
Under new Centers for Medicare & Medicaid Services (CMS) guidance, D-SNPs are prioritized as the preferred coverage model for people who are dually eligible. Rather than treating Medicare and Medicaid as different entities, D-SNPs bundle care coordination, combining hospital, medical and prescription drug coverage with care management, aligned provider networks and support for medical, behavioral health and long-term care needs.
Plans must now provide one ID card for both Medicare and Medicaid, conduct a single integrated health risk assessment and follow set timelines for creating individualized care plans with input from beneficiaries.
New special enrollment period: When can you switch plans?
Depending on your eligibility you can now switch plans monthly. In 2025, CMS ended the long-standing special enrollment period (SEP) that previously allowed dual-eligible beneficiaries to switch Medicare Advantage or Part D
plans every three months. In its place, CMS created a monthly integrated care SEP, which allows full-benefit beneficiaries to change plans only if they are moving into an integrated D-SNP, specifically a fully integrated, highly integrated or applicable-integrated plan. The change reflects CMS’s intent to steer enrollment toward plans that deliver truly integrated, person-centered care rather than loosely coordinated coverage.
Unified appeals and grievances
Under CMS’s integrated care requirements, D-SNPs now must administer a unified appeals and grievance process for members whose benefits are aligned under the same plan. This removes the frustrating burden of figuring out whether a problem should be handled by Medicare or Medicaid.
Now, beneficiaries file a single appeal or grievance through their plan. They no longer need to submit separate appeals or work with two different agencies. The plan is responsible for coordinating the review, applying the correct Medicare and Medicaid requirements and working with the state Medicaid agency when necessary.
CMS expects the unified process to simplify dispute resolution, reduce administrative burden and make it easier for dual-eligible individuals to challenge coverage decisions without unnecessary delays or paperwork.
Ending of VBID models
CMS ended the Medicare Advantage Value?Based Insurance Design (VBID) model in 2025. Under VBID, plans had greater flexibility to offer broad supplemental benefits, often called “wallets,” for items such as groceries, utilities or transportation, based on criteria beyond just health status.
In 2026, many of the nonmedical supports that beneficiaries value continue through Special Supplemental Benefits for the Chronically Ill (SSBCI) but with stricter eligibility rules. Unlike VBID, SSBCI benefits generally can only be offered to enrollees who have one or more documented chronic conditions, such as diabetes, chronic heart failure or COPD, and the benefit must be expected to improve or maintain health or overall function.
How to remain dual eligible
Remaining dual eligible for both Medicare and Medicaid requires meeting the financial and program-specific criteria for each program. Once you’re enrolled, Medicare coverage is permanent. However, different states have different annual re-enrollment or renewal requirements for Medicaid, so check with your state’s Medicaid office.
“The process ensures that beneficiaries still meet the eligibility requirements, particularly by verifying income and asset levels,” Roberts says. “The re-enrollment process and timing varies by state.”
Medicaid beneficiaries are required to keep countable assets like savings, investments or secondary properties within the state’s limits.
State and community resources on dual eligibility
With recent changes reshaping the system, choosing the best plan can feel confusing and raise questions. The good news is that there is plenty of free help out there.
“There are several state-level resources available to help individuals navigate the complexities of dual eligibility,” Johnston says.
Some organizations include:
— Administration for Community Living (ACL). The ACL is a federal agency that works to promote the well-being and independence of older adults and individuals with disabilities. Through partnerships with state and local organizations, the ACL ensures access to resources and services that can assist with understanding and applying for dual-eligibility programs.
— Area Agencies on Aging (AAA). Area Agencies on Aging are community-based organizations that offer support tailored to older adults. They provide a wide range of services, including assistance with Medicare and Medicaid enrollment, understanding benefits and connecting individuals to local resources. These agencies can be especially helpful for figuring out the eligibility requirements for dual programs.
— State Health Insurance Assistance Programs (SHIP). SHIPs are free counseling programs available in every state, and they are designed to help Medicare beneficiaries understand their coverage options. SHIP counselors provide unbiased, one-on-one assistance with topics like Medicare benefits, Medicaid dual eligibility, enrollment processes and billing issues. SHIP services are particularly valuable for those who need help coordinating the benefits of both programs.
Bottom Line
With several million Americans dually eligible for both Medicare and Medicaid, it’s important to know how the programs work together and what benefits and coverage options are available. Those with full-benefit dual eligibility receive comprehensive Medicaid coverage, including long-term care, while partial-benefit beneficiaries receive more limited assistance, typically with Medicare premiums, deductibles and copayments. To find out if you are dual eligible, individuals must enroll in Medicare first and then apply for Medicaid, meeting their state’s income, asset and other eligibility requirements.
Recent changes in 2026 aim to simplify and strengthen dual eligibility coverage. D-SNPs now coordinate Medicare and Medicaid coverage under one plan. Changes also include D-SNPs being prioritized as the preferred coverage model for people who are dually eligible, a new monthly special enrollment period where qualified beneficiaries may change plans, the appeals and grievances process has been streamlined, and VBID benefits have been replaced by SSBCI benefits with stricter eligibility rules. State and community resources, like SHIP and Area Agencies on Aging, can help beneficiaries navigate these programs and stay enrolled in the benefits they qualify for.
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What Is Medicare-Medicaid Dual Eligibility? originally appeared on usnews.com
Update 02/13/26: This story was published at an earlier date and has been updated with new information.
