People who qualify for both Medicare and Medicaid get broader coverage and significantly lower healthcare costs. If you have Medicare and your income or assets are limited, you may be eligible for programs that pay your premiums, reduce cost-sharing, or cover services Medicare does not.
What “Dual Eligible” Means
A person is considered “dual eligible” when they qualify for both Medicare (federal insurance for people 65+ or with a disability) and Medicaid (state-run insurance for people with limited income and assets). About 12 million Americans are dual eligible. These two programs coordinate to provide more complete coverage than either program alone.
Medicare Savings Programs
Medicare Savings Programs (MSPs) are Medicaid programs that help pay Medicare costs. There are four types, each with different income limits. All are administered through your state Medicaid agency. Income and asset limits vary by state.
Qualified Medicare Beneficiary (QMB)
QMB is the broadest program. It covers your Part A premium (if any), Part B premium, and most cost-sharing — deductibles, coinsurance, and copays. Providers are not allowed to bill QMB participants for cost-sharing, even for Medicare-covered services. QMB is available to individuals with incomes up to roughly 100% of the federal poverty level.
Specified Low-Income Medicare Beneficiary (SLMB)
SLMB pays your Part B premium only. It does not cover deductibles or other cost-sharing. Income limit is roughly 120% of the federal poverty level. Even paying just the Part B premium saves about $2,220 per year at 2025 rates.
Qualifying Individual (QI)
QI also pays the Part B premium, similar to SLMB, but income limits extend to about 135% of the federal poverty level. QI requires annual reapplication, and funding is limited — earlier applications in the year are more likely to be approved.
Qualified Disabled and Working Individuals (QDWI)
QDWI is a smaller program for working people with disabilities who lost Medicare when they returned to work. It pays the Part A premium for those who no longer qualify for premium-free Part A due to their work activity.
How to Apply for MSPs
Apply through your state Medicaid agency. Many states allow you to apply for Medicare Savings Programs at the same time as Medicaid. You can also apply through your local Social Security office. Approval must be renewed annually in most states, though some states have auto-renewal.
Extra Help for Part D
Extra Help — also called Low Income Subsidy (LIS) — is a federal program that reduces Part D prescription drug costs for people with limited income and assets. It can eliminate or dramatically reduce Part D premiums, deductibles, and copays. If you qualify for a full MSP, you automatically qualify for Extra Help.
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How Medicaid Fills Medicare’s Gaps
For people who have both programs, Medicaid often covers services that Medicare does not, including:
- Long-term care — nursing home and home-based personal care that Medicare only covers short-term
- Dental, vision, and hearing services — routine care that Medicare excludes
- Transportation to medical appointments
- Personal care and home health aide services beyond what Medicare covers
The specific services Medicaid covers depend on your state. States must cover certain mandatory services but have wide latitude on optional coverage.
D-SNPs — Medicare Advantage for Dual Eligibles
Dual Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed specifically for people with both Medicare and Medicaid. D-SNPs coordinate benefits from both programs, often with a single care management team, lower or no cost-sharing, and extra benefits such as meals after hospital discharge, transportation, or over-the-counter drug allowances.
Not all D-SNPs provide the same level of Medicaid benefit coordination. Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) provide the most complete integration and are available in some states. Compare D-SNP options carefully against remaining in Original Medicare with a full MSP.
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Related Topics
Medicare Parts A, B, C, D Explained
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