If you’re wondering who is eligible for both Medicare and Medicaid, the short answer is this: you likely qualify if you have Medicare (usually because you’re 65 or older, or you have a qualifying disability) and you also have a low enough income to get Medicaid in your state. People who have both are called dual eligible, and there’s a single plan built just for them. Below, we’ll walk through the plain rules for each program, how the two fit together, and how to check your own status without any pressure.
Millions of people are in this exact spot and don’t know it. Around 12 million Americans qualify for both programs, yet only about 44 percent are enrolled in the plan made for them. That gap usually comes down to one thing: nobody ever told them they could have both.
Who is eligible for both Medicare and Medicaid?
To have both, you need to meet the rules for each program separately. They come from two different places, so you qualify for them on two different tests.
Medicare is federal health coverage. Most people get it when they turn 65. You can also get it younger than 65 if you’ve received Social Security disability for two years, or if you have certain conditions like ALS or end stage kidney disease.
Medicaid is a joint federal and state program for people with limited income and resources. Each state sets its own income limits, so the exact cutoff depends on where you live. If your monthly income and savings fall under your state’s line, you may qualify.
When you meet both sets of rules at the same time, you’re dual eligible. That’s the group these plans are designed for, and it’s the answer to the question of who is eligible for both Medicare and Medicaid.
The simple version
Think of it as two doors. Medicare opens because of your age or a disability. Medicaid opens because of your income. If you can walk through both doors, you’re dual eligible, and a dual plan can bring the two together for you.
How do the two programs work together?
When you have both, one program becomes your main coverage and the other helps with what’s left. For most people, Medicare pays first for doctors and hospital care, and Medicaid helps cover costs Medicare doesn’t, like many co pays, deductibles, and some services Medicare leaves out.
A Dual Eligible Special Needs Plan, often shortened to DSNP, is a type of Medicare Advantage plan that rolls your Medicare and Medicaid coverage into one plan with one card. Instead of juggling two programs, you get a single plan built around people who have both.
Here’s the part that surprises people most: joining a dual plan does not make you lose your Medicaid. You keep your Medicaid, and the dual plan works alongside it. That’s worth repeating, because worry about “losing” something keeps a lot of eligible people from ever looking into it.
What might a dual plan include?
Because these plans serve people with both programs, they often come with more than basic Medicare. Exact benefits vary by plan, county, and carrier, and they change every year, so treat any figure as a sample to confirm, not a promise. On many plans, if you’re eligible, you may see:
- A $0 monthly premium on most dual plans.
- An allowance card for groceries or over the counter items, worth up to a set amount each month on many plans.
- Dental, vision, and hearing coverage.
- Rides to and from medical visits.
These extras are real benefits on many plans, but they’re always “up to” a limit and only “if eligible.” They are not free money and they are not a government check. They’re features of a private plan that a licensed insurance agent can walk you through for your area.
How to check if you’re dual eligible
You don’t need to guess. A few quick questions usually tell you where you stand.
Do you have Medicare? If you’re 65 or older, or you’ve been on Social Security disability, the answer is probably yes. Your red, white, and blue Medicare card is the proof.
Do you have Medicaid, or a very limited income? If you already have a Medicaid card, you’re set on that side. If you’re not sure, low monthly income and modest savings are the signal that you might qualify. Some people qualify for help with their Medicare costs even before full Medicaid.
Not sure about one of them? That’s the most common answer, and it’s exactly why a quick call helps. A licensed agent can check what’s available in your county and tell you whether you appear to qualify, at no cost and with no obligation. You can also learn more on our Am I Dual Eligible page first.
What if you qualify for only one right now?
Plenty of people have Medicare but aren’t sure about Medicaid, or the other way around. That doesn’t shut the door. It just means one side may still need to be confirmed.
If you have Medicare and your income is limited, you might qualify for Medicaid or for one of the programs that help pay your Medicare costs, such as help with your Part B premium. These often open the door to a dual plan too. And if your income has recently dropped, you may qualify now even if you didn’t before.
The point is that eligibility isn’t always obvious from the outside. Income limits differ by state, and the rules have several ways in. So if you’re close on either side, it’s worth having someone check rather than assuming you’re out.
When can you sign up?
One nice thing about being dual eligible is flexibility. People who have both Medicare and Medicaid can usually change plans more often than other folks, rather than waiting only for the fall enrollment window. If you find out you qualify, you often don’t have to wait long to act.
Why so many eligible people miss out
More than half of the people who could have a dual plan aren’t in one. The reasons are usually simple and fixable.
Some never heard the term “dual eligible” and assume Medicare and Medicaid can’t be held together. Others worry that signing up for something new means giving up coverage they already have. And many just find the whole thing confusing and put it off.
None of those are good reasons to miss out on benefits you’re entitled to. If you’re still sorting out how the two programs differ, our guide on the difference between Medicare and Medicaid lays it out in plain language, and our What Is a Dual Plan page explains how they come together.
Key takeaways
- You’re dual eligible when you qualify for Medicare (age 65 or older, or a qualifying disability) and Medicaid (limited income) at the same time.
- A dual plan (DSNP) combines both into one plan with one card, and you keep your Medicaid.
- Many dual plans offer a $0 premium plus extras like an allowance card, dental, vision, and rides, always up to a limit and if eligible.
- About 12 million people qualify, but only around 44 percent are enrolled, so if you’re unsure, it’s worth checking.
Frequently asked questions
Can I have Medicare and Medicaid at the same time?
Yes. Many people have both, and there’s a plan designed for exactly that situation. Having both is what makes you dual eligible.
Will I lose my Medicaid if I join a dual plan?
No. You keep your Medicaid. A dual plan works alongside it and brings your coverage together in one place.
Do I have to pay a monthly premium?
Most dual plans have a $0 monthly premium, though this varies by plan and county. A licensed agent can confirm what’s offered where you live.
How do I find out if I qualify?
The fastest way is a quick, free call. A licensed agent can check your county and tell you whether you appear to be eligible, with no obligation to sign up.
Ready to see if you qualify?
If you have Medicare and a limited income, there’s a good chance you’re eligible for both programs and the plan built around them. The only way to know for your county is to ask. Call to speak with a licensed insurance agent who can check your options for free, with no pressure and no obligation.
Call (800) 000-0000My Dual Plan is a private information and referral service. We are not an insurance company, an insurance agency, or a licensed producer, and we are not affiliated with, endorsed by, or connected to Medicare, Medicaid, CMS, or any government agency. When you call, you’ll be connected with a licensed insurance agent who can discuss the dual special needs plans they offer in your area. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.