Both programs
Medicare and Medicaid — dual eligibility.
Some people qualify for both Medicare (age/disability) and Medicaid (income). Here is how they coordinate and the special plans built for dual-eligible enrollees.
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What dual eligibility means
"Dual eligible" describes someone enrolled in both Medicare and Medicaid. Medicare pays first for covered services. Medicaid picks up most or all of the Medicare cost-sharing (deductibles, copays) and may cover additional services Medicare does not.
Categories of dual eligibility
- Full dual eligible (FBDE) — qualifies for full Medicaid benefits in addition to Medicare
- Partial dual eligible — qualifies for Medicaid help paying Medicare costs through a Medicare Savings Program (QMB, SLMB, QI)
Dual Special Needs Plans (D-SNPs)
D-SNPs are Medicare Advantage plans specifically designed for dual-eligible members. They coordinate Medicare and Medicaid benefits into one plan and often include extras like:
- $0 plan premium
- Dental, vision, hearing benefits
- Over-the-counter (OTC) allowances
- Transportation to medical appointments
- Meal benefits after hospital stays
See our Special Needs Plans guide.