What Are Dual Eligible Medicare-Medicaid Plans?

by Matt Clements, Senior Editor,
Reviewed by John Krahnert, Compliance Director,
Nov 09, 2023

Dual eligible Medicare-Medicaid plans are a special type of Medicare Advantage plan for people eligible for both Medicare and Medicaid. These types of plans, also called D-SNPs or Dual-Eligible Special Needs Plans, aren’t available in all areas.

Dual eligible Medicare Medicaid plans are a type of Medicare Advantage plan designed for people who are eligible for both Medicare and Medicaid. These plans are commonly called Dual-Eligible Special Needs Plans (D-SNP).

Dual eligible Medicare-Medicaid plans are available in most states, but it's important to compare your local plan options to learn more about what's available where you live.

Who Qualifies for Dual Eligibility?

Dually eligible beneficiaries are those who are eligible for Medicare and who meet specific financial criteria to qualify for Medicaid in their state.

To qualify for both Medicare and Medicaid benefits:

You must be aged 65 or older or have a qualifying disability or condition such as end-stage renal disease (ESRD) or Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease).
You must have limited income and/or financial resources that fall below certain thresholds set by your state's Medicaid program and qualify you for Medicaid.
You must be a U.S. citizen or have been lawfully admitted as a permanent resident for at least 5 continuous years.

What Are Medicare Savings Programs?

Regardless of whether you qualify for Medicaid in your state, you may qualify for help with some out-of-pocket Medicare expenses like premiums, deductibles, copayments and coinsurance through a Medicare Savings Program (MSP) if you qualify.

The 4 Medicare Savings Programs are:

Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)
Qualifying Individual (QI) programs
Qualifying Individual (QI) program

Learn more about Medicare Savings Program eligibility, including the lates income limits and other qualifications.

How to Apply for Dual Eligible Medicare Medicaid Plans

Before applying, make sure that you meet the eligibility requirements for both Medicare and Medicaid.

To apply, you'll need to provide various documents as proof of your identity, citizenship status, income level, assets, medical expenses, etc. Some of the documents you may need include:

Social Security card or number
Proof of U.S. citizenship or lawful permanent resident status
Pay slips or tax returns showing your income
Bank statements detailing your financial resources
Copies of any unpaid medical bills

If you are not already enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance), visit the Social Security Administration (SSA) website to submit an online application. Alternatively, you can call SSA at 1-800-772-1213 (TTY: 1-800-325-0778).

Medicaid is administered by individual states, so the application process may vary depending on where you live.

Visit your state's Medicaid agency website to learn about eligibility criteria and find out how to sign up for Medicaid in your state. You can also call 1-800-MEDICARE (1-800-633-4227; TTY: 1-877-486-2048) for more information.

In order to then apply for a dual eligible Medicare Medicaid plan, you can call to speak with a licensed insurance agent who can help you enroll over the phone if you're eligible and if a D-SNP dual eligible.

How Many U.S. Citizens Are Eligible for Both Medicare and Medicaid?

As of 2023, 12 million Americans were dual eligible for Medicare and Medicaid.¹

Conclusion

If you're eligible for both Medicare and Medicaid, you may be able to benefit from a Medicare Special Needs Plan, if any are offered where you live. These plans cover prescription drug costs, help coordinate your care between Medicare and Medicaid and may offer additional benefits not covered by Original Medicare alone.

Check your Medicaid eligibility with your state's Medicaid office. If you're eligible and are enrolled in Medicare Part A and Part B, you may be able to apply for a Medicare Advantage plan during certain enrollment periods. To learn more and to check your eligibility, call to speak with a licensed insurance agent or request a free plan quote online.

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

1 Centers for Medicare & Medicaid Services (CMS). (Jul 31, 2023). Access to Health Coverage. https://www.cms.gov/pillar/expand-access.