Medicare and Medicaid — dual eligibility.
Some seniors qualify for both. Medicaid fills gaps Medicare leaves. Here is how they coordinate and the special plans built for dual-eligible people.
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What dual eligibility means
"Dual eligible" describes someone who qualifies for both Medicare (federal program based on age or disability) AND Medicaid (state-federal program for low income).
For dual-eligible people, Medicare pays first for covered services, and Medicaid picks up most or all of what Medicare leaves.
Categories of dual eligibility
- Full dual eligibility — qualifies for full Medicaid benefits
- Partial dual eligibility — qualifies for one of the Medicare Savings Programs (QMB, SLMB, QI). See our MSP guide.
Dual Special Needs Plans (D-SNPs)
D-SNPs are Medicare Advantage plans built specifically for dual-eligible people. They coordinate Medicare and Medicaid benefits and often include $0 premiums and extra benefits like transportation, OTC allowances, and dental.
To enroll in a D-SNP, you typically need to be enrolled in both Medicare and Medicaid in the state where the plan operates.