To qualify for both Medicare and Medicaid, you need to meet each program’s specific requirements. For Medicare, eligibility is typically based on age (65 or older) or specific health conditions, such as a disability or end-stage renal disease.

In contrast, Medicaid is need-based, meaning your eligibility depends on your income and financial resources, which vary depending on the state where you live.

What is dual eligibility?

If you already have Medicare, you can apply for Medicaid through your state’s Medicaid office to determine if you qualify for dual eligibility. Similarly, if you are on Medicaid and turning 65 or meet Medicare’s other criteria, you should apply for Medicare as soon as possible to ensure coordinated coverage.

Each state’s Medicaid office can provide guidance on the specific income and asset limits to help you understand whether you meet the eligibility criteria.

Once qualified, Medicare usually serves as the primary payer for covered services, while Medicaid acts as the secondary payer, covering costs that Medicare may not fully cover, such as certain deductibles, co-payments, and services such as long-term care that Medicare doesn’t typically include.

Dual-eligible individuals may also qualify for Medicare Savings Programs, which assist with Medicare premiums and other expenses.

“People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you’re a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have,” the official Medicare website reads.

“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. Medicaid may still cover some drugs that Medicare doesn’t cover.”