Dual eligibility: when you have both Medicare and Medicaid

How Medicare and Medicaid work together for dual-eligible people, what each pays, D-SNP plans, and long-term services and supports.

About 12 million Americans qualify for both Medicare and Medicaid. They are called dual eligibles. For them, Medicare pays first and Medicaid fills many of the gaps.

What each program pays

• Medicare pays first for hospital, doctor and drug costs.
• Medicaid pays Medicare premiums and cost sharing (for full duals) and covers services Medicare does not, such as long-term nursing home care and home and community-based services.

Full vs partial duals

• Full duals have full Medicaid benefits plus Medicare.
• Partial duals qualify only for a Medicare Savings Program (see MSPs).

Dual Special Needs Plans

Many duals can join a D-SNP, a Medicare Advantage plan designed for people with both programs. These plans coordinate benefits, often include extras, and in some states integrate Medicaid services. Rules for enrolling and switching have been changing; duals can now change plans in more limited windows than before, so check current rules.

Long-term services and supports

Medicaid is the main payer for long-term care in the U.S. In Washington, long-term services and supports are administered through DSHS; in Florida, through the Statewide Medicaid Managed Care Long-term Care program.

Medigap is rarely needed

Full duals generally do not need Medigap because Medicaid covers Medicare cost sharing. Partial duals may still benefit from supplemental coverage.

Getting help

State Health Insurance Assistance Programs (SHIBA in Washington, SHINE in Florida) and Area Agencies on Aging can help duals sort out coverage and enrollment.

Questions people ask

What is a dual eligible?

Someone who qualifies for both Medicare and Medicaid.

Which pays first?

Medicare pays first; Medicaid pays after.

What is a D-SNP?

A Medicare Advantage plan designed for dual eligibles.

Do duals need Medigap?

Full duals usually do not; partial duals sometimes do.

Independent educational site. Not affiliated with or endorsed by the U.S. government, the federal Medicare program, or any insurance company. Figures are 2026 amounts published by CMS unless noted; check Medicare.gov for your situation.