What is a partial dual?

A partial dual has Medicare and qualifies for a Medicare Savings Program (QMB, SLMB, QI or QDWI) but not for full Medicaid benefits. The program helps with Medicare premiums and, for QMB, Medicare cost sharing.

Can partial duals join a D-SNP?

Federal rules allow it to the extent the state's contract with the D-SNP permits. Some states limit their most integrated programs to people with full Medicaid, so availability for partial duals depends on the state and the plan.

How do I find out which category I am in?

Look at your Medicaid approval letter or call your state Medicaid agency. A simple question helps too: does your Medicaid pay for doctor visits and other health care, or does it only help with Medicare premiums and costs?

Do partial duals get Extra Help?

Most do. Medicare.gov says people in a Medicare Savings Program that pays the Part B premium (QMB, SLMB or QI) get Extra Help with drug costs automatically, as do people with full Medicaid or SSI. QDWI pays the Part A premium, so it does not bring Extra Help automatically; people in QDWI can apply for Extra Help.

Which monthly enrollment options apply to partial duals?

Partial duals can use the once-a-month dual/LIS Special Enrollment Period to move to Original Medicare with a stand-alone drug plan or change drug plans. The once-a-month integrated care option is for full-benefit duals only.

Full vs. Partial Dual Eligibility: What Your Medicaid Category Means

By Alexander James, Licensed Independent Insurance Agent · NPN 19291077

Part of our guide to Medicare and Medicaid together.

Full dual

Medicare plus full Medicaid: Medicaid health benefits as well as help with Medicare costs.

Partial dual

Medicare plus a Medicare Savings Program only (QMB, SLMB, QI or QDWI): help paying Medicare premiums and, for QMB, Medicare cost sharing, but not full Medicaid benefits.

The categories, in plain words

Federal guidance lists the Medicaid categories that may be able to join a D-SNP: full Medicaid only, QMB only, QMB Plus, SLMB only, SLMB Plus, QI and QDWI. Here is what each program pays, as Medicare.gov describes it:

Full Medicaid: Medicaid health benefits under your state's program, plus help with Medicare costs. Long-term care coverage depends on the state program and your needs.
QMB (Qualified Medicare Beneficiary): Pays the Part A premium if you owe one, the Part B premium, and Medicare deductibles, coinsurance and copays. Medicare providers may not bill you for Medicare-covered cost sharing.
SLMB (Specified Low-Income Medicare Beneficiary): Pays the Part B premium only.
QI (Qualifying Individual): Pays the Part B premium. You apply every year, help is first-come first-served, and it is only for people who do not qualify for other Medicaid.
QDWI (Qualified Disabled and Working Individual): Pays the Part A premium for certain working people with disabilities who no longer get Part A without a premium.

The income and resource limits for each program, with their year, are in our guide to the Medicare Savings Programs.

Why your category matters for plan choices

Federal rules allow partial duals to join D-SNPs, but only to the extent the state's contract with the plan permits. The state contract sets which Medicaid categories each D-SNP may enroll. That is why two neighbors with “Medicaid” can have different options.

The most integrated state programs are often limited to full Medicaid. For example, each of these state programs, as described by the state, is for full-benefit duals:

Ohio
Next Generation MyCare requires full Medicaid. Ohio guide
Indiana
Partial duals can enroll in coordination-only D-SNPs but do not qualify for the PathWays Dual Care program, the state says. Indiana guide
Michigan
The state says the partial-benefit groups (QMB, SLMB, QI, ALMB and QDWI) are not eligible for MI Coordinated Health. Michigan guide
Texas
The state limits its integrated D-SNP option to full-benefit dual adults in five counties. Texas guide

The 2027 federal limit of one D-SNP per company per area, where that company also runs a Medicaid plan in the area, applies to plans for full-benefit duals. CMS says a company may still offer a separate D-SNP for partial duals where state policy allows.

Enrollment options differ too

Since 2025, full duals, partial duals and people with Extra Help can all use the once-a-month dual/LIS Special Enrollment Period to move to Original Medicare with a stand-alone drug plan or to change drug plans. The once-a-month integrated care option, which lets someone join a FIDE SNP, HIDE SNP or applicable integrated plan to line up with their Medicaid plan, is for full-benefit duals only.

FAQ

Frequently asked

Sources

Each page was read on October 23, 2026.

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