Dually Eligible for Medicare and Medicaid

Is it possible for my loved one to be eligible for Medicare and Medicaid? How do I know and what does it mean?

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Medicare and/or Medicaid

Helpful Highlights

It is possible for your loved one to be eligible for both Medicare and Medicaid. Financially, this would make a difference in health care costs for your loved one.

Even though they are both categorized under the Center for Medicare and Medicaid Services (CMS), Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.

Here are some basics... 

Medicare 

Medicaid 

Eligibility for Medicaid

Dual eligibility

People who qualify for both Medicare and Medicaid coverage are called “dually eligible.” In dual eligibility, Medicare-covered services are received and Medicare pays first. Medicaid pays last, after Medicare and any other health insurance your loved one has (such as a partial pension plan).

With dual eligibility, your loved one can still choose how they want to receive their Medicare coverage - either through Original Medicare (Parts A & B) or through a Medicare Advantage plan (Part C).  

What Medicaid pays for

With Medicare and Medicaid coverage, the state will pay for Medicare Part B monthly premiums. The state will also pay Part A premiums (if your loved one is required to pay them).

Depending on the level of Medicaid qualified for, the state might also pay for your loved one's share of Medicare costs, like deductibles, coinsurance, and copayments.

Medicaid offers extra help with drug costs and may pay for drugs and other services that Medicare doesn't cover.

How to apply for Medicaid

Contact your state Medical Assistance (Medicaid) office.

Working together

Medicaid provides secondary insurance for services covered by Medicare and Medicaid, such as provider visits, hospital care, home care, and skilled nursing facility care.

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RESOURCES

Beneficiaries Dually Eligible for Medicare and Medicaid

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Likewise, no content in this app, regardless of date, should ever be used as a substitute for direct advice from a licensed insurance broker or other qualified plan-payer professional.

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