Medicare and Medicaid Together: A Guide for Dual-Eligible People

You are dual eligible when you have Medicare (because you are 65 or older, or because of a disability) and you also qualify for help from your state's Medicaid program. There are two broad groups. People with full Medicaid get Medicaid health benefits as well as help with Medicare costs. People who qualify only for a Medicare Savings Program (QMB, SLMB, QI or QDWI) get help paying Medicare premiums and, for QMB, Medicare cost sharing, but not full Medicaid benefits. These are often called “partial duals.”

Which group you are in matters: it decides which bills are paid and which Medicare plan types you can join. Our guide to full versus partial dual eligibility walks through each category. Your state Medicaid agency, not a plan or an agent, decides whether you qualify. Medicare.gov puts it simply: the rules around who is eligible for Medicaid are different in each state.

Medicare.gov describes the order plainly. When you have Medicare and full Medicaid and you get a Medicare-covered service, Medicare pays first. Medicaid pays last, after Medicare and any other health insurance you have. Your prescription drugs are covered by Medicare: people with full Medicaid are enrolled in a Medicare drug plan, which covers drugs instead of Medicaid.

Many people assume that once they have Medicare and Medicaid, everything is covered and handled. Often a lot is covered. But Medicare and Medicaid are separate programs with their own rules, and they are often run by separate organizations. With Original Medicare and Medicaid, you are the one holding the two together: which card to show, which program to call, which letter matters.

That gap is what D-SNPs exist to close. Federal rules describe a D-SNP as a plan that coordinates the delivery of Medicare and Medicaid services, and every D-SNP must have a contract with your state Medicaid agency.

A Dual Eligible Special Needs Plan is a type of Medicare Advantage plan for people who are also entitled to Medicaid. Under federal rules it coordinates Medicare and Medicaid, it may cover some Medicaid services (such as long-term care or behavioral health), and it must have a contract with the state Medicaid agency.

To join one, Medicare.gov lists three requirements:

Every special needs plan includes Medicare drug coverage and provides care coordination. Special needs plans are HMO or PPO plans, and they cover the same Part A and Part B services that all Medicare Advantage plans cover. Some plans include additional benefits; benefits vary by plan.

Insurance companies decide where they offer special needs plans, so what is available differs from county to county and state to state.

Not every D-SNP works the same way. Since 2021, every D-SNP has had to meet at least one integration standard. Think of it as a ladder. At the first step, a coordination-only D-SNP coordinates with Medicaid but does not cover your Medicaid benefits itself. At the second, a HIDE SNP (highly integrated) is paired with a state Medicaid contract held by the same organization or its parent. At the top, a FIDE SNP (fully integrated) covers Medicare and Medicaid together through one organization.

Why the level matters to you: in the most integrated plans you get one combined appeals and grievance process instead of two, and FIDE plans coordinate or integrate member materials and enrollment. Some states also require that you have the matching Medicaid plan from the same company. Our guide to integrated D-SNPs and the 2027 changes goes step by step.

A federal rule finalized in 2024 (CMS-4205-F) is reshaping D-SNPs in stages, and a 2026 rule kept its dates in place.

Members who are not aligned may stay in these D-SNPs until 2030. States also run their own programs on top of these rules, which is why our state guides below matter.

Since January 1, 2025, there are two once-a-month options:

Other plan changes use the usual windows: your Initial Enrollment Period, the Annual Enrollment Period (October 15 through December 7), the Medicare Advantage Open Enrollment Period (January 1 through March 31) and other Special Enrollment Periods. Our guide to Medicare Special Enrollment Periods covers the rest.

A D-SNP is not right for everyone, and it helps to know what can change before you decide:

Even if you do not have full Medicaid, you may get help with Medicare costs. The Medicare Savings Programs help with Part A and Part B costs, and Extra Help lowers prescription drug costs. Medicare.gov says people with full Medicaid, SSI, or a Medicare Savings Program that pays their Part B premium (QMB, SLMB or QI) get Extra Help automatically. If you or a spouse may need nursing-home or in-home care, our Medicaid long-term care basics cover the look-back, estate recovery and spousal protections.

Each state runs its own Medicaid program and its own approach to integrated plans. These guides cover the state program names, the 2026 and 2027 picture and the state's published income figures.

A licensed agent can explain how the plans they offer in your area work with your Medicaid, check your doctors and prescriptions against a plan's network, and help you understand the enrollment windows that apply to you. You can also get impartial help from your State Health Insurance Assistance Program (SHIP), and your state Medicaid agency answers questions about Medicaid eligibility. There is no obligation to enroll in anything.