Dual Eligible Guide for Seniors – How to Get Both Medicare and Medicaid

2026 Dual Eligible Guide: Income Limits, Benefits & How to Apply (Save $6,000+ Annually)

Last updated: January 07, 2026

Reviewed by: Sarah Martinez, Certified Benefits Counselor, and the Grants for Seniors Research Team

Our senior benefits guide for 2026 shows how stacking MSPs, Extra Help, and SNAP can realistically add hundreds of dollars in monthly relief.

⚠️ If You Need Emergency Help

Don’t wait to get help if you’re having trouble with your Medicare or Medicaid benefits:

• For Medicare issues: Call Medicare directly at 1-800-MEDICARE (1-800-633-4227), available 24/7
• For Medicaid issues: Contact your state Medicaid office (find yours at Medicaid.gov/state-overviews)
• For help applying for benefits: Call your local State Health Insurance Assistance Program (SHIP) at 1-877-839-2675
• For food assistance: Call 211 to find local food banks and meal programs. The Area Agency on Aging directory connects you to local counselors who can screen benefits and help submit applications at no cost.
• For housing help: Contact your local Area Agency on Aging at 1-800-677-1116

Key Takeaways

Bottom Line: If you qualify for both Medicare and Medicaid, you can get much better health coverage at little to no cost. About 12.8 million Americans are “dual eligible,” and this could save you thousands of dollars per year.

What You Get:

• All your Medicare premiums, deductibles, and copays covered
• Extra prescription drug help (pay only up to $4.90 for generics, $12.15 for brand-name drugs in 2026)
• Long-term care that Medicare doesn’t cover
• Transportation to medical appointments
• Special Medicare plans designed just for dual eligibles.

This unclaimed benefits overview explains why billions go unused each year and how to avoid leaving money on the table.

2026 Income Limits (Most States):

• Single person: Up to $1,275/month for full benefits (Federal Poverty Guidelines 2026)
• Married couple: Up to $1,717/month for full benefits
• Higher income limits available for partial benefits (up to $1,781 single/$2,400 couple)

What Does “Dual Eligible” Mean?

Being “dual eligible” simply means you qualify for both Medicare and Medicaid at the same time. You’re not choosing one or the other – you get both programs working together to cover your health care costs.

Here’s how it works:

• Medicare pays first for covered services (like doctor visits and hospital stays)
• Medicaid picks up what Medicare doesn’t cover, including copays, deductibles, and services Medicare doesn’t provide

According to CMS data from 2026, this dual coverage serves 7.2 million low-income seniors plus 5.6 million people with disabilities who are also on Medicare. Medicaid for seniors basics clarifies what Medicaid covers beyond Medicare, including long-term care and help with cost-sharing.

Real Example: Maria, 67, from Phoenix, was paying $185/month for Medicare Part B plus $400/month for prescriptions. After qualifying as dual eligible, she now pays $0 for Part B and just $4.90 per prescription – saving her over $6,500 annually.

Who Qualifies?

You can be dual eligible if you meet requirements for both programs:

Medicare Requirements:

• Age 65 or older, OR
• Under 65 with certain disabilities, OR
• End-stage kidney disease, OR
• ALS (Lou Gehrig’s disease)

Medicaid Requirements:

• Low income (see income tables below)
• Limited assets
• U.S. citizen or qualified immigrant
• Resident of the state where you’re applying

A quick rundown of eligibility rules and proofs to gather can reduce back-and-forth during Medicare and Medicaid applications.

Types of Dual Eligible Coverage

Not everyone gets the same level of dual eligible benefits. There are two main types: Full Dual Eligible Benefits and Partial Dual Eligible Benefits. This Medicare Savings Programs overview compares QMB, SLMB, and QI and notes where asset limits don’t apply.

Full Dual Eligible Benefits

You get complete Medicaid coverage plus Medicare. This means:

• Medicaid pays all your Medicare premiums, deductibles, and copays
• You get all Medicaid services like nursing home care, home health aides, and transportation
• You pay almost nothing out-of-pocket for health care

When full Medicaid isn’t immediately available, charities that can fill care gaps may help with food, utilities, or short-term costs.

Partial Dual Eligible Benefits (Medicare Savings Programs)

You get help with Medicare costs but not full Medicaid. There are four programs:

1. Qualified Medicare Beneficiary (QMB)

What it covers: All Medicare premiums, deductibles, and copays 2026 Income Limits (Federal Register, January 2026):

• Single: $1,275/month ($15,300/year)
• Couple: $1,717/month ($20,604/year) Asset Limits: $9,430 (single), $14,130 (couple)

2. Specified Low-Income Medicare Beneficiary (SLMB)

What it covers: Medicare Part B premium only 2026 Income Limits:

• Single: $1,530/month ($18,360/year)
• Couple: $2,060/month ($24,720/year) Asset Limits: $9,430 (single), $14,130 (couple)

3. Qualifying Individual (QI)

What it covers: Medicare Part B premium only 2025 Income Limits:

• Single: $1,721/month ($20,652/year)
• Couple: $2,318/month ($27,816/year) Asset Limits: $9,430 (single), $14,130 (couple) Important: Limited funding – apply early each year, first-come first-served

4. Qualified Disabled Working Individual (QDWI)

What it covers: Medicare Part A premium for people with disabilities who returned to work Requirements: Must be under 65, disabled, working, and lost free Medicare Part A due to work income.

An MSPs step-by-step guide walks through QMB, SLMB, and QI with current 2026 limits and application tips.

2026 Income and Asset Limits

A primer on how income and assets are counted helps predict eligibility when numbers are close to the line.

*Full Medicaid limits vary significantly by state. Contact your state Medicaid office for exact amounts.

Reality Check: Some states have no asset limits or higher income limits. Twelve states currently have no asset limits for Medicare Savings Programs: Alabama, Arizona, Connecticut, Delaware, Louisiana, Maine, Mississippi, New Mexico, New York, Oregon, Vermont, and Washington D.C.

Important Warning About Estate Recovery: Federal law requires states to recover costs from estates of Medicaid beneficiaries for long-term care services received after age 55. This doesn’t affect Medicare Savings Programs (QMB, SLMB, QI) but does apply to full Medicaid benefits.

What Assets Don’t Count

When determining if you qualify, these assets are typically NOT counted:

• Your home (primary residence)
• One car
• Personal belongings and household items
• Burial plots and up to $1,500 in burial funds
• Life insurance with face value under $1,500
• Property needed for work or business

Warning: The asset limits are strict for most programs. If you’re close to the limit, consider speaking with a benefits counselor about legal ways to reduce countable assets.

A printable benefits checklist keeps non-countable assets straight and prevents avoidable documentation mistakes.

Extra Help with Prescription Drugs

Extra Help details for 2026 cover copay caps, asset rules, and how decisions are issued. All dual eligible individuals automatically qualify for “Extra Help” with Medicare Part D prescription drug costs. In 2026, this means:

What You Pay for Prescriptions

• Generic drugs: $0-$4.90 per prescription (CMS Part D Coverage 2026)
• Brand-name drugs: $0-$12.15 per prescription
• No coverage gap (donut hole)
• No late enrollment penalties

Low-cost dental and pharmacy options can further reduce out-of-pocket costs when medications and oral care strain a fixed income.

Estimated Annual Savings

The Social Security Administration estimates this Extra Help benefit averages $5,900 per year for people who take multiple medications. Programs that offset health expenses may cover transportation, medical bills, or case management while benefits are pending.

Medicare Advantage Plans for Dual Eligibles

If you’re dual eligible, you have access to special Medicare Advantage plans called Dual Eligible Special Needs Plans (D-SNPs). These plans:

• Combine your Medicare and Medicaid benefits into one plan
• Often have $0 monthly premiums
• Include prescription drug coverage
• Offer extra benefits like transportation, food allowances, and home modifications
• Coordinate your care between Medicare and Medicaid services

A rundown of what Medicare Advantage typically includes highlights extras like dental, hearing, and transportation in many D-SNPs.

Types of D-SNPs

Guidance on choosing between D-SNPs and Original Medicare compares coordination benefits versus provider choice.

Reality Check: Not all areas have D-SNPs available. Rural areas especially may have limited options. You can keep Original Medicare if you prefer, but D-SNPs often provide better coordination and extra benefits.

Long-Term Care Benefits

This is where being dual eligible really shines. Medicare only covers skilled nursing care for up to 100 days and only when you’re recovering from a hospital stay. Medicaid covers:

• Nursing home care indefinitely
• Home health aides for daily activities
• Adult day care programs
• Assisted living (in many states)
• Home modifications for safety and accessibility

A clear look at how nursing home costs transition to Medicaid helps families plan before savings are exhausted.

Home and Community-Based Services (HCBS)

Most states offer HCBS waivers that let you get long-term care at home instead of a nursing home. Services can include:

• Personal care assistance
• Meal delivery
• Transportation
• Home modifications (ramps, grab bars)
• Adult day programs
• Respite care for family caregivers

Safety upgrades and accessibility help—like grab bars or ramps—are often available through home repair and weatherization programs.

Tip: There are often waiting lists for HCBS services. Apply as soon as you think you might need help, even if it’s not immediate.

Special Considerations for Different Groups

National and community organizations listed here can supplement benefits with transportation, food, and legal assistance.

Veteran Seniors

If you’re a veteran, you have unique options:

• VA benefits can work alongside Medicare and Medicaid
• CHAMPVA may provide additional coverage for family members
• VA nursing homes may accept Medicaid payments
• Service-connected disabilities can qualify you for additional VA benefits regardless of income

Veterans with 100% disability ratings get comprehensive VA healthcare that coordinates with Medicare/Medicaid.

Contact: Call the VA at 1-800-827-1000 for help coordinating benefits.

Expert Insight: “Veterans often don’t realize they can use VA healthcare alongside Medicare and Medicaid,” says Dr. Michael Torres, VA Benefits Counselor. “The coordination can provide comprehensive coverage with minimal out-of-pocket costs, especially for service-connected conditions.”

Veteran-focused assistance programs can help coordinate VA healthcare with Medicare and Medicaid coverage.

LGBTQ+ Seniors

LGBTQ+ older adults face unique challenges but have the same rights to Medicare and Medicaid services:

• Non-discrimination protections apply to all Medicare and Medicaid funded services
• Medicaid long-term care cannot discriminate based on sexual orientation or gender identity
• Same-sex spouses have the same Medicare and Medicaid rights as opposite-sex couples
• Gender-affirming care may be covered by Medicaid in many states

Over 1.2 million LGBTQ+ older adults rely on Medicaid for healthcare access.

Resources:

• SAGE National LGBT Elder Hotline: 1-877-360-LGBT
• Justice in Aging LGBTQ+ Resources

Community Voice: “Finding affirming healthcare as an older transgender woman was challenging until I learned about my rights under Medicaid,” shares Linda K., 72, from San Francisco. “Now my gender-affirming care is covered, and I have access to culturally competent providers.”

Benefits counselors with interpreter access can help LGBTQ+ elders navigate complex enrollments in a respectful setting.

Native American and Alaska Native Seniors

American Indian and Alaska Native (AI/AN) dual eligibles have special protections:

• No cost-sharing for services received at Indian Health Service, Tribal, or Urban Indian health facilities
• No Medicaid premiums or enrollment fees if eligible for I/T/U services
• 100% federal match for Medicaid services at I/T/U facilities
• Special enrollment rights for Marketplace plans year-round

Contact: Find your local tribal health program or call the Indian Health Service at 1-301-443-3593.

Tribal and national resources for elders can bridge care while state Medicaid processes applications.

Disabled Seniors

If you became eligible for Medicare due to disability:

• You may have Medicare before age 65
• SSDI benefits often continue alongside Medicare
• Work incentives allow you to try working while keeping benefits
• Ticket to Work program provides vocational rehabilitation services

Tip: People with disabilities under 65 who are dual eligible often face unique challenges accessing care, especially in rural areas and for mental health services.

SSDI and Medicare coordination guidance explains work incentives and how coverage continues during transitions.

Rural Seniors

Rural dual eligibles face specific challenges:

• Provider shortages especially for specialists and mental health
• Transportation barriers to medical appointments
• Limited D-SNP options or no plans available
• Longer travel distances for care

Solutions:

• Medicaid transportation is required in all states for medical appointments
• Telehealth services expanded under Medicare and Medicaid
• Rural Health Clinics often accept both Medicare and Medicaid
• Area Agencies on Aging provide local transportation programs

Transportation programs for rural areas outline Medicaid rides, local shuttles, and tips for scheduling in advance.

Contact: National Aging and Disability Transportation Center at 1-866-983-3222 for local transportation resources.

Rural Reality: “Living 45 minutes from the nearest doctor meant I was skipping appointments,” explains Robert M., 68, from rural Montana. “Once I learned about Medicaid transportation and telehealth options through my D-SNP, I haven’t missed an appointment in two years.”

Transportation Benefits

This senior transportation guide compares Medicaid rides, Medicare Advantage benefits, and local low-cost options. Getting to medical appointments is often a major challenge for seniors. Here’s what’s available:

Medicaid Transportation

All states must provide transportation to Medicaid appointments, including:

• Medical and dental appointments
• Mental health services
• Pharmacy visits
• Medicaid-covered services

Local help arranging medical rides is available through Area Agencies on Aging and SHIP counselors.

Reality Check: The type of transportation varies by state – it might be a medical van, taxi, bus vouchers, or mileage reimbursement.

Medicare Advantage Transportation

Many D-SNPs and other Medicare Advantage plans now offer:

• Rides to/from medical appointments
• Grocery store trips
• Pharmacy visits
• Some social activities

A quick look at how MA plans bundle extra benefits explains ride allowances alongside dental, vision, and hearing.

Other Transportation Options

• Area Agencies on Aging: Call 1-800-677-1116
• 211: Dial 2-1-1 for local transportation resources
• Religious organizations and community groups
• Senior center transportation programs

Nonprofits offering rides and escorts can fill gaps when program transportation is unavailable or waitlisted.

How to Apply

Free, unbiased application help is available through local AAAs and SHIP counselors who can sit with you to complete forms.

For Medicare Savings Programs (QMB, SLMB, QI)

1. Contact your state Medicaid office (each state runs these programs differently)
2. Apply at your local Social Services office
3. Online applications available in most states
4. Required documents:
   • Social Security card
   • Medicare card
   • Proof of income (Social Security statements, pay stubs)
   • Bank statements
   • Proof of address

An MSP application checklist outlines documents to gather and common reasons decisions get delayed.

For Full Medicaid

1. Apply through your state Medicaid office
2. Healthcare.gov for some states
3. Local Social Services departments
4. Hospital financial counselors can often help with applications

Full Medicaid eligibility by state explains waivers, income rules, and how to contact your state office.

Tip: Don’t assume you won’t qualify. Income and asset limits vary by state, and many people who think they earn “too much” actually qualify for help.

Common Problems and Solutions

A one-page tool to keep proofs and renewals organized reduces interruptions during Medicaid redeterminations.

Problem: Providers Don’t Accept Your Coverage

Solution:

• Make sure providers understand you have both Medicare and Medicaid
• Show both cards at every appointment
• QMB beneficiaries cannot be balance billed – report violations to Medicare

Local counselors can help you find providers who take your plan and report QMB balance-billing issues.

Problem: Medicaid Renewal Delays

Solution:

• Submit renewals early
• Keep copies of all paperwork
• Contact your state Medicaid office if benefits are interrupted
• Know your rights – you can appeal coverage decisions

Practical tips to avoid missed benefits include early renewals, updated contact info, and tracking mailed notices.

Problem: Prescription Drug Coverage Gaps

Solution:

• Understand that Medicare handles your prescription coverage, not Medicaid
• Use Medicare Plan Finder to compare drug plans
• Ask about generic alternatives
• Look into manufacturer assistance programs

Low-cost clinics and patient assistance programs can help when your plan doesn’t cover a needed prescription or procedure.

Problem: Long Wait Times for Services

Solution:

• Apply for HCBS services early, even if you don’t need them immediately
• Ask about emergency or urgent priority categories
• Consider private pay options while waiting for Medicaid approval

Bridge support while you wait may come from nonprofits offering food, case management, or small emergency grants.

Money-Saving Tips

A roundup of quick wins that lower costs fast shows where seniors typically save first while bigger approvals are processing.

Prescription Drugs

• Always use generic versions when available
• Mail-order pharmacies often cost less
• Manufacturer patient assistance programs for expensive drugs
• GoodRx and similar programs may be cheaper than your copay for some drugs

Extra Help application pointers cover how to avoid penalties and what to expect after you submit.

Medical Equipment

• Rent vs. buy – Medicaid often prefers rental for wheelchairs, hospital beds
• Prior authorization – get approval before ordering expensive equipment
• Multiple quotes – shop around for approved suppliers

Programs that assist with DME can provide loan closets or donated equipment when prior authorization is pending.

Dental Care

• Medicaid dental coverage varies dramatically by state
• Community health centers often provide sliding-scale dental care
• Dental schools offer low-cost care by students under supervision

A Donated Dental Services step-by-step explains eligibility, waitlists, and how to prepare for the intake call.

Frequently Asked Questions (FAQs)

Q: If I have both Medicare and Medicaid, which one pays first?

A: Medicare always pays first for services it covers. Medicaid then pays Medicare’s deductibles, copays, and services Medicare doesn’t cover.

Q: Will having Medicaid affect my Medicare benefits?

A: No, Medicaid enhances your Medicare benefits. You keep all Medicare services and gain additional coverage through Medicaid.

Q: Can I lose my dual eligible status?

A: Yes, if your income increases or you gain assets above the limits. However, you can reapply if your situation changes again. Some states have “spend-down” programs that let you qualify by paying medical expenses to reduce your countable income.

Q: What happens to my benefits when I die? Will my family lose our home?

A: Medicare Savings Programs (QMB, SLMB, QI) have no estate recovery. Full Medicaid may pursue estate recovery for long-term care costs paid after age 55, but your home is generally protected if a spouse, disabled child, or child under 21 lives there. State rules vary significantly.

Q: Do I need to choose between Original Medicare and Medicare Advantage if I’m dual eligible?

A: You can choose either. Medicare Advantage D-SNPs offer coordinated care, but Original Medicare gives you more provider choice.

Q: What if my state didn’t expand Medicaid?

A: You can still qualify for Medicare Savings Programs (QMB, SLMB, QI) which help with Medicare costs, even in non-expansion states.

Q: Can I have both Medicaid and private insurance?

A: Yes, but Medicaid typically pays last after Medicare and any other insurance.

Q: How often do I need to reapply for benefits?

A: Most states require annual renewal for Medicaid benefits. Medicare Savings Programs also require yearly applications.

Q: What if I disagree with a coverage decision?

A: You have appeal rights for both Medicare and Medicaid decisions. Contact the program that denied coverage for specific appeal procedures.

Q: Can Medicaid help pay for my spouse’s Medicare costs?

A: Medicaid can only help with Medicare costs for the person who qualifies. However, spousal income rules may allow one spouse to qualify while the other doesn’t.

Q: What happens to my benefits if I move to another state?

A: You’ll need to reapply in your new state. Benefits and eligibility rules vary by state.

The Grants for Seniors home hub links to state pages, calculators, and popular guides for deeper answers.

Program Details

Medicaid programs by state outline waivers, buy-in options, and who to call for case-specific answers.

Program of All-Inclusive Care for the Elderly (PACE)

What it is: PACE provides comprehensive medical and social services for people 55+ who need nursing home-level care but want to live at home.

What it covers:

• All Medicare and Medicaid services
• Transportation to PACE centers
• Adult day care
• Home care services
• Prescription drugs
• Medical equipment

How it works: You get all your care through a PACE center. A team of doctors, nurses, social workers, and therapists coordinate everything.

Cost: If you’re dual eligible, you typically pay nothing for PACE services.

Availability: PACE programs exist in 31 states but aren’t available everywhere.

Guidance on getting to PACE and medical visits covers ride options and how to arrange transportation through local programs.

Medicaid Buy-In Programs

Some states allow people with higher incomes to “buy in” to Medicaid by paying a monthly premium. This can be valuable if:

• Your income is slightly above Medicaid limits
• You need Medicaid’s long-term care services
• You want Medicaid’s comprehensive coverage

A quick overview of who benefits from Medicaid buy-in explains when paying a premium makes sense to keep coverage.

State Pharmaceutical Assistance Programs (SPAPs)

Several states offer additional prescription drug help beyond Medicare Extra Help:

• Pennsylvania: PACE and PACENET programs
• New Jersey: Pharmaceutical Assistance to the Aged and Disabled
• Delaware: Prescription Assistance Program
• States with SPAPs often provide: Lower copays, coverage during the donut hole, help with Medicare Part D premiums

State drug help beyond Extra Help can reduce copays or cover gaps that Part D doesn’t fully handle.

Resources by Region

To find your local AAA, use the directory and ask about transportation, case management, and benefits counseling in your county.

National Resources

• Medicare: 1-800-MEDICARE (1-800-633-4227) | Medicare.gov
• Medicaid: Medicaid.gov/state-overviews
• SHIP (State Health Insurance Assistance Program): 1-877-839-2675 | ShipHelp.org
• Area Agencies on Aging: 1-800-677-1116 | Eldercare Locator
• Benefits CheckUp: BenefitsCheckUp.org – Find all benefits you might qualify for

A list of national nonprofits serving seniors can help with immediate food, utility, and legal support.

State-Specific Help

Each state runs Medicaid differently. Contact your state’s specific agencies:

Find your state Medicaid office: Medicaid.gov/state-overviews

State Health Insurance Assistance Programs (SHIP): Every state has free, unbiased Medicare counseling. Find yours at ShipHelp.org

State contacts and benefits counselors can walk you through MSP and Medicaid applications step-by-step.

Legal Help

• National Center on Law and Elder Rights: NCLER.acl.gov
• Justice in Aging: JusticeInAging.org
• Center for Medicare Advocacy: MedicareAdvocacy.org

Legal aid and elder rights resources listed here offer free help with denials and appeals in many states.

About This Guide

Researched and Compiled by Grants for Seniors

This guide has been carefully researched using publicly available government resources and official program websites. We systematically review federal and state program information to create comprehensive, accurate guides for older Americans seeking grant opportunities.

Our Sources: All information comes from official sources including federal agency websites (HHS, USDA, SSA, CMS), state government departments, official program documentation, and verified nonprofit organization resources.

Verification Process: Each program listing undergoes thorough online verification by cross-referencing information across multiple official sources, checking current program status, verifying contact information, and confirming eligibility requirements and deadlines.

Information Currency:

• Last Updated: January 2026
• Sources Verified: January 2026
• Next Review: April 2026

Important Note: Government programs can change without advance notice. While this guide uses the most current available information, we strongly recommend verifying all details directly with program administrators before applying.

Found an Error? If you discover outdated information or additional programs that should be included, please contact us at info@grantsforseniors.org.

Disclaimer: This guide is for informational purposes only and does not constitute professional advice. Always confirm program details with official sources before applying. Program details can change, and readers should always verify information with the relevant agency. Editorial Standards explains how we verify program limits and update timelines across our senior benefit guides.

This resource is independently researched to help seniors access available financial assistance programs.