Dual Eligible Medicare and Medicaid Seniors

How Medicare and Medicaid coordinate, plus the savings dual status unlocks — free help at 1-800-MEDIGAP.

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Quick answer

Dual eligible seniors qualify for both Medicare and Medicaid. Medicare pays first for hospital and medical care, and Medicaid covers what Medicare does not, including long-term care, premiums, and most out-of-pocket costs. This can reduce expenses to near zero. Call 1-800-MEDIGAP (1-800-633-4427).

Being dual eligible for Medicare and Medicaid is one of the most valuable positions a senior can be in. Here is how the two programs work together in 2026.

How do Medicare and Medicaid work together?

When you are dual eligible, Medicare is the primary payer and Medicaid is secondary. Medicare covers hospital stays (Part A), doctor visits (Part B), and prescriptions (Part D), while Medicaid fills the gaps, paying your Medicare premiums, deductibles, copays, and coinsurance, plus services Medicare excludes such as long-term nursing home care, in-home support, and some dental, vision, and hearing care. The result is that most dual eligible seniors pay little to nothing out of pocket. Coordinating both programs correctly maximizes your benefits. Call 1-800-MEDIGAP (1-800-633-4427) to make sure you are getting everything you are entitled to.

What are the levels of dual eligibility?

Dual eligibility comes in two main forms. Full dual eligible seniors receive complete Medicaid benefits plus help with Medicare costs. Partial dual eligible seniors qualify for a Medicare Savings Program that pays some or all of their Medicare premiums and cost-sharing, but not full Medicaid services. There are also Dual Eligible Special Needs Plans (D-SNPs), Medicare Advantage plans built specifically to coordinate care for dual members, often with extra benefits. Which category fits you depends on your income and assets. A 1-800-MEDIGAP specialist can determine your level and enroll you in the right coverage.

More on Medicaid for Seniors

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Frequently asked questions

What does it mean to be dual eligible?+

Dual eligible means you qualify for both Medicare and Medicaid at the same time. Medicare pays first for medical care, and Medicaid covers remaining costs and services Medicare does not, like long-term care. This combination minimizes out-of-pocket expenses for low-income seniors.

What does Medicaid pay for dual eligible seniors?+

For dual eligible seniors, Medicaid typically pays Medicare premiums, deductibles, and copays, plus services Medicare excludes such as long-term nursing home care, in-home personal care, and often dental, vision, and hearing. Benefits vary by state and dual eligibility level. Call 1-800-MEDIGAP for details.

What is a Dual Eligible Special Needs Plan (D-SNP)?+

A D-SNP is a type of Medicare Advantage plan designed for people with both Medicare and Medicaid. It coordinates benefits from both programs in one plan, often adding extras like transportation, over-the-counter allowances, and care coordination. 1-800-MEDIGAP can check if a D-SNP fits you.

Do dual eligible seniors pay premiums?+

Usually not. Full dual eligible seniors typically have their Medicare Part A and Part B premiums paid by Medicaid, and they often qualify for full prescription drug subsidies. The result is little to no monthly cost. Call 1-800-MEDIGAP to confirm your premium coverage.

How do I become dual eligible?+

If you already have Medicare, apply for Medicaid through your state agency. If you meet your state's income and asset limits, you become dual eligible and the programs coordinate automatically. 1-800-MEDIGAP (1-800-633-4427) can review your finances and help you apply for free.

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