Key Takeaways

• If you qualify for both Medicare and Medicaid, you may be able to access additional healthcare benefits at a lower cost. Understanding eligibility rules, enrollment periods, and covered services is crucial to making the most of your benefits.

• Dual eligibility can help reduce out-of-pocket expenses, but it’s important to know how Medicare and Medicaid work together, what’s covered, and how to avoid gaps in coverage.

What Does It Mean to Be Dual-Eligible?

If you qualify for both Medicare and Medicaid, you are considered dual-eligible. This means you can benefit from both programs, which work together to cover healthcare costs like hospital stays, doctor visits, and prescription drugs. Medicare generally acts as the primary payer, while Medicaid helps cover costs like premiums, deductibles, and copayments.

1. Do You Meet the Income and Asset Limits for Medicaid?

Medicaid eligibility is based on income and assets, which vary by state. In 2025, income limits are determined using the Federal Poverty Level (FPL), and they may change annually. Some states have expanded Medicaid under the Affordable Care Act, allowing more individuals to qualify. If your income is slightly above the limit, you may still qualify under a Medicaid spend-down program.

Understanding Asset Limits

Assets such as savings accounts, investments, and property (other than your primary home) may affect eligibility. Medicaid generally allows you to keep a modest amount of assets, but the limits depend on your state’s rules.

2. When Should You Apply for Medicare and Medicaid?

Medicare enrollment typically starts three months before your 65th birthday and continues for three months after. If you miss this Initial Enrollment Period (IEP), you may face late penalties. Medicaid applications are accepted year-round, but processing times vary by state.

Special Enrollment Periods (SEP)

If you qualify for both Medicare and Medicaid, you may be eligible for a Special Enrollment Period. This allows you to make changes to your Medicare coverage outside the standard enrollment periods.

3. What Parts of Medicare Will You Need?

Being dual-eligible doesn’t mean Medicare works differently, but you’ll still need to understand the different parts:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, and hospice care.

• Part B (Medical Insurance): Covers doctor visits, outpatient services, and preventive care.

• Part D (Prescription Drug Coverage): Helps cover medication costs.

• Medicaid: May help cover some out-of-pocket costs not covered by Medicare.

4. How Does Medicaid Work with Medicare?

Medicaid can help pay for Medicare premiums, deductibles, and co-pays. Depending on your income level, you may qualify for a Medicare Savings Program (MSP), which helps cover these costs. Medicaid may also offer additional services that Medicare doesn’t cover, such as vision and dental care.

Full vs. Partial Dual Eligibility

• Full dual-eligible beneficiaries receive full Medicaid benefits in addition to Medicare coverage.

• Partial dual-eligible beneficiaries receive assistance with Medicare premiums and cost-sharing but may not qualify for full Medicaid services.

5. What Medical Services Will Be Covered?

Medicare and Medicaid together cover a broad range of healthcare services, but there may still be gaps. Medicaid often covers services not included under Medicare, such as long-term care, dental, and vision services. Coverage details depend on the state you live in.

6. Will You Have to Pay Any Out-of-Pocket Costs?

Medicaid can help reduce your out-of-pocket expenses by covering Medicare premiums, deductibles, and co-pays. However, if your Medicaid coverage is limited, you may still have some out-of-pocket expenses. Checking your state’s Medicaid benefits can help you determine what costs will be covered.

7. How Can You Avoid Losing Eligibility?

Changes in income or assets can affect Medicaid eligibility. Regular reviews ensure that you still qualify. If your income rises above the limit, you may lose Medicaid benefits. Planning ahead and reporting income changes to your state Medicaid office can help avoid coverage disruptions.

8. How Do You Enroll in Both Medicare and Medicaid?

Applying for both programs requires separate applications:

• Medicare: Enroll through the Social Security Administration (SSA) website or your local SSA office.

• Medicaid: Apply through your state Medicaid agency. Many states offer online applications.

If you qualify for Medicaid first, you will still need to apply for Medicare when eligible. Some people are automatically enrolled in Medicare if they receive Supplemental Security Income (SSI) benefits.

9. Who Can Help You Make the Right Choice?

Enrolling in Medicare and Medicaid can be complex. Speaking with a licensed agent listed on this website can help you understand your options, ensure you’re receiving all the benefits available to you, and avoid common mistakes.

Understanding Dual Eligibility Can Help You Save on Healthcare Costs

Applying for both Medicare and Medicaid can significantly reduce your healthcare expenses. Knowing the income limits, coverage options, and cost-sharing benefits will help you maximize your benefits and avoid unnecessary costs.

For personalized guidance, connect with a licensed agent listed on this website who can help you understand Medicare and find the right coverage for your needs.