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Have Both Medicare and Medicaid? What's Covered and What You Pay in 2026

Title Tag:** Have Both Medicare and Medicaid? What's Covered and What You Pay in 2026 **Meta Description:** If you have both Medicare and Medicaid in 2026, you may pay very little or nothing for healthcare. Learn what's covered, what each program pays, and how to get the most from both.

**Important Disclaimer:**

*This information is for educational purposes only and does not constitute marketing of any specific Medicare plan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. This material is not affiliated with or endorsed by the federal Medicare program.*

**Have Both Medicare and Medicaid? Here's What's Covered and What You'll Pay in 2026**

**Quick Answer:** Seniors who are enrolled in both Medicaid and Medicare have all of the benefits of both programs, which results in lower out-of-pocket costs and more comprehensive coverage. Medicare pays first when you get Medicare-covered services, and Medicaid pays last, after Medicare and any other health insurance you have. For many people who have both, the out-of-pocket cost for most healthcare is very small — sometimes zero. This guide explains exactly how the two programs work together in 2026, in plain language.

You might be in this situation without even knowing there's a name for it. You're on Medicare — maybe because you're 65 or older, or because you have a disability. And you're also on Medicaid — because your income and assets are limited. Having both at the same time is more common than most people realize. About 12 million Americans have both Medicare and Medicaid coverage, known as being "dual eligible," meaning they get benefits from both programs to help pay healthcare costs.

The good news: people who qualify for both Medicare and Medicaid may have access to additional financial protections and benefits that help lower their healthcare costs. Here's how it all works.

**The Simple Way to Think About It**

Think of Medicare and Medicaid as two puzzle pieces that fit together. In most cases, Medicare is your primary plan and covers most Medicare-eligible healthcare services. Medicaid is typically the secondary plan and may cover medical costs that Medicare doesn't cover or partially covers.

In other words:

• **Medicare pays first** — for hospital stays, doctor visits, medical equipment, and more
• **Medicaid steps in second** — to cover what Medicare didn't pay, like your deductibles, copays, and services Medicare doesn't include at all
• **You often pay little or nothing** — because between the two programs, most costs are covered

For those who are dual eligible, Medicare always acts as the primary insurance, while Medicaid steps in to fill the gaps, helping to pay for costs that Medicare doesn't cover, such as premiums, deductibles, and coinsurance. Think of them as two puzzle pieces that work together to pay for your healthcare expenses.

**What Medicare Covers (Your Primary Coverage)**

Medicare covers the medical side of your healthcare. Here's a quick overview of each part:

• **Part A (Hospital Insurance):** Covers inpatient hospital stays, skilled nursing facility care (after a qualifying hospital stay), hospice, and some home health care. The 2026 deductible for Medicare Part A is $1,736. If you have Medicaid, it may cover this deductible for you.
• **Part B (Medical Insurance):** Covers doctor visits, outpatient care, preventive services, and durable medical equipment. The premium for Medicare Part B in 2026 is $202.90 per month. There is a $283 annual deductible for Medicare Part B in 2026. Again, Medicaid may cover these costs depending on your program.
• **Part D (Prescription Drugs):** If you're dually eligible, Medicare covers your prescription drugs. You'll automatically be enrolled in a Medicare drug plan that will cover your drug costs instead of Medicaid. If Medicare doesn't cover your prescription, Medicaid may still cover it in certain situations.

**What Medicaid Covers That Medicare Doesn't**

This is where having both programs becomes especially valuable. Medicaid offers benefits not normally covered by Medicare, like nursing home care and personal care services.

Medicaid can also cover:

• **Your Medicare premiums** — Medicaid may pay your monthly Part B premium ($202.90 in 2026) so it never comes out of your Social Security check
• **Your deductibles and copays** — so you don't pay the $1,736 Part A hospital deductible or the 20% coinsurance for doctor visits
• **Long-term care** — long-term care benefits are provided by Medicaid, not Medicare, but some Medicare Advantage plans offer limited long-term care benefits
• **Dental, vision, and hearing** — depending on your state's Medicaid program
• **Personal care services** — help with bathing, dressing, and daily living activities that Medicare won't pay for
• **Durable Medical Equipment** — both Medicaid and Medicare will provide durable medical equipment, such as wheelchairs and walkers

**What Do You Actually Pay? The Real Numbers for 2026**

This is the question most people really want answered. The honest answer is: it depends on which type of dual eligibility you have. There are two main categories.

**If You Have Full Medicaid**

For seniors with full Medicaid coverage, Medicaid will often pay for their Medicare Part A and Part B premiums. That means your $202.90 monthly Part B premium is paid for you — a savings of over $2,400 a year before you factor in deductibles and copays. In many cases, your out-of-pocket costs for covered services are zero or very close to it.

**If You Have a Medicare Savings Program (Partial Medicaid)**

Not everyone qualifies for full Medicaid, but you may still qualify for a Medicare Savings Program — and that still counts as dual eligibility. Medicare Savings Programs are state-administered programs that help people with limited income and resources pay for their Medicare costs. If you qualify for an MSP, your state Medicaid program will pay some or all of your Medicare premiums, deductibles, and coinsurance.

There are three main programs:

**QMB — Qualified Medicare Beneficiary (the most helpful)** QMB is the most comprehensive Medicare Savings Program. It covers your Medicare Part B premium, Medicare Part A premium (if you have one), and all Medicare deductibles, coinsurance, and copays. Medical providers are not allowed to bill QMB beneficiaries for Medicare cost-sharing — if a provider tries to bill you, you have the right to refuse to pay.

To qualify for QMB in 2026: the income limits are $1,350 per month for an individual and $1,824 per month for a couple, and the asset limits are $9,950 for an individual and $14,910 for a couple.

**SLMB — Specified Low-Income Medicare Beneficiary** SLMB covers your Medicare Part B premium. That's $202.90 per month in 2026 — over $2,400 a year back in your pocket. The 2026 income limits are $1,616 per month for an individual and $2,184 per month for a couple, and the asset limits are $9,950 for an individual and $14,910 for a couple.

**QI — Qualifying Individual** The QI Program helps pay Part B premiums for people who have Part A. QI applications are granted on a first-come, first-served basis, and you must apply each year. The 2026 income limits are $1,816 per month for an individual and $2,455 per month for a couple, and the asset limits are $9,950 for an individual and $14,910 for a couple.

**The savings add up fast.** QMB is the most important one because it can pay the Part A premium, the Part B premium, and the costs that cause problems during the year: the deductible and coinsurance/copays for Medicare services. In dollars, this translates to saving anywhere from $2,500 to $6,000 each year, depending on your medical needs and your type of Medicare plan.

**One important asset note:** people sometimes give up too soon because they mix everyday assets with countable resources. Resources include liquid assets such as savings accounts, stocks, or bonds. Your home, car, and personal belongings generally don't count. Don't assume you won't qualify just because you have some savings — the rules are more generous than most people think.

**Your Prescription Drug Costs with Both Programs**

Prescription drug coverage for dual-eligible individuals is primarily handled through Medicare Part D, but it is heavily subsidized by a program called Extra Help (also known as the Low-Income Subsidy or LIS). If a person is dual eligible (full or partial), they automatically qualify for the Extra Help program. This means they do not have to pay a separate monthly premium for their drug plan, and the annual deductible is usually reduced to $0.

Even with Extra Help, an individual may still have a small copayment when they pick up their medicine. For 2026, the costs are capped at low rates. Specifically, Extra Help enrollees have no deductible and fixed, lower copayments — up to $5.10 for generic and $12.65 for brand-name drugs in 2026.

MSP enrollment also automatically qualifies you for the Part D Low Income Subsidy (Extra Help). So even if you only qualify for partial Medicaid through a Medicare Savings Program, you still get the prescription drug help.

**A Special Type of Plan for People With Both: The D-SNP**

If you have both Medicare and Medicaid, there's a type of Medicare Advantage plan designed specifically for you — worth knowing about even if it's not right for everyone.

A Dual Special Needs Plan (D-SNP) is a type of Medicare Advantage plan designed exclusively for people who qualify for both Medicare and Medicaid. D-SNPs coordinate benefits from both programs into a single plan, often with $0 premiums, $0 or low copays, and extra benefits like dental, vision, hearing, transportation, and over-the-counter allowances that Original Medicare does not cover.

With a D-SNP, you'll be assigned a care coordinator from your plan provider to develop a care plan to help you achieve your best health.

A few things to know:

• Partial dual eligibility (through a Medicare Savings Program) may not be enough for all D-SNPs — not all D-SNPs accept individuals with partial dual eligibility, and some plans are only available to those with full dual eligibility. Check before enrolling.
• D-SNPs vary by state and county — not every plan is available everywhere
• Joining a D-SNP is a choice, not a requirement — you can keep Original Medicare and your Medicaid side by side if you prefer

This post is educational and doesn't recommend specific plans — for plan comparisons in your area, Medicare.gov's Plan Finder is the right tool.

**How to Find Out If You Qualify**

Because Medicare is not income-based, it's the Medicaid side that determines if you qualify for dual eligible status.

Here's how to check:

1. **Call your state Medicaid office** — they handle Medicare Savings Program applications and can tell you which program you qualify for. This is the fastest route.
2. **Call Social Security at 1-800-772-1213** — they can help with Extra Help applications.
3. **Visit Medicare.gov** and search "Medicare Savings Programs" for your state.
4. **Contact your local SHIP** (State Health Insurance Assistance Program) — free, unbiased counseling from trained advisors who know your state's specific rules.

If your income is anywhere near the limits, it's worth applying. Ask for an assessment at the nearest Medicaid office. Even if you are not 100% certain, the application will be worth your time. The worst that can happen is that your application will be denied, and the best that can happen is that you'll get thousands of dollars each year.

You will need to bring proof of your income, proof of your assets, and your Medicare cards. The application process will take under an hour.

**A Note on State Differences**

Eligibility requirements for Medicaid are not as straightforward as they are for Medicare, because each state sets their own requirements within federally set parameters. Even within the same state, there are a variety of pathways to Medicaid eligibility and each pathway has its own criteria.

Some states are significantly more generous than the federal minimums. For example, Alaska, Connecticut, the District of Columbia, Hawaii, and Maine have higher income limits. Some states, such as California and Minnesota, have a higher asset limit, and other states don't have an asset limit at all. Always check with your state Medicaid office for your exact numbers — the federal figures in this post are the baseline, not the ceiling.

**Frequently Asked Questions**

**If I have both Medicare and Medicaid, do I have to pay anything?**

It depends on which type of dual eligibility you have. With full Medicaid, most people pay very little or nothing for covered services — Medicaid covers your Medicare premiums, deductibles, and copays. With a Medicare Savings Program, you get at least your Part B premium ($202.90/month in 2026) covered, and the QMB program covers all Medicare cost-sharing. Either way, your out-of-pocket costs are significantly lower than Medicare alone.

**Does Medicaid pay my Medicare premium?**

For seniors with full Medicaid coverage, Medicaid will often pay for their Medicare Part A and Part B premiums. Even with partial Medicaid through a Medicare Savings Program, three of the four MSPs cover the Part B premium, which in 2026 is $202.90 a month for most people — for a total savings of $2,435 each year.

**What does Medicaid cover that Medicare doesn't?**

The biggest gaps Medicare leaves that Medicaid can fill include: long-term nursing home care, personal care services (help with daily activities), and — depending on your state — dental, vision, and hearing. Medicaid also covers some expenses that Medicare does not, such as long-term nursing home care and personal care services.

**Do I get help with prescription drug costs if I have both?**

Yes — and it's significant. If you have both Medicare and Medicaid, you automatically qualify for Extra Help (also called the Low-Income Subsidy), which dramatically reduces your prescription drug costs. In 2026, that means no annual deductible for your drug plan, and copays capped at $5.10 for generics and $12.65 for brand-name drugs. For many people, this saves hundreds or even thousands of dollars a year on medications.

**What is a D-SNP and do I need one?**

A Dual Special Needs Plan (D-SNP) is a type of Medicare Advantage plan designed exclusively for people who qualify for both Medicare and Medicaid. It coordinates both programs into one plan, often with $0 premiums and extra benefits like dental, vision, hearing, and transportation. You don't have to enroll in one — you can keep Original Medicare alongside your Medicaid — but for many dual-eligible individuals, a D-SNP simplifies things and adds extra benefits. Use Medicare.gov's Plan Finder to see what's available in your area.

**How do I apply for dual eligibility or a Medicare Savings Program?**

Contact your state Medicaid office — they handle the application and can tell you which program you qualify for. You can also call Social Security at 1-800-772-1213 for Extra Help, or contact your local SHIP for free guidance. Bring proof of income, proof of assets, and your Medicare card. Even if you're not sure you'll qualify, it's always worth applying.

**What if I tried to qualify before and was turned down?**

Rules change, and income and asset limits are adjusted periodically. If you were denied in the past, it's worth reapplying — especially if your financial situation has changed, or if your state has expanded its Medicaid eligibility. Don't assume a past denial is permanent.

**The Bottom Line: If You Have Both, Use Both**

Having both Medicare and Medicaid is genuinely one of the most comprehensive coverage combinations available in the American healthcare system. Medicare handles the medical heavy lifting, and Medicaid fills in the gaps — premiums, deductibles, copays, long-term care, and services Medicare simply doesn't cover.

The biggest mistake people make is not knowing they qualify, or assuming the application isn't worth their time. For seniors with full Medicaid coverage, Medicaid will often pay for their Medicare Part A and Part B premiums — and even partial help through a Medicare Savings Program can save you thousands of dollars a year.

If you think you might qualify — or if you're not sure — the single best step you can take today is to call your state Medicaid office or your local SHIP. It's free, it takes less than an hour, and the potential savings are real and lasting.

**Need Additional Help?**

For questions about Medicare, Medicaid, or whether you qualify for dual coverage:

• Visit Medicare.gov to learn more about Medicare Savings Programs and Extra Help
• Call 1-800-MEDICARE for guidance on your Medicare coverage
• Call Social Security at 1-800-772-1213 to apply for Extra Help
• Contact your state Medicaid office to apply for a Medicare Savings Program
• Contact your local State Health Insurance Assistance Program (SHIP) for free, personalized counseling

**Required Compliance Disclaimers:**

*For agent use only. Not affiliated with the U.S. federal government or federal Medicare program. This information is provided for educational purposes only and does not constitute marketing of any specific Medicare plan.*

*For official Medicare information, please visit Medicare.gov or call 1-800-MEDICARE. You can also contact your local State Health Insurance Program (SHIP) for personalized assistance.*