12 Million Americans Have Both Medicare and Medicaid: What That Means

If you or someone you love is enrolled in both Medicare and Medicaid, you are part of a group of approximately 12 million Americans known as dual-eligible individuals. This is not a niche population — it represents roughly one in five people on Medicare nationwide. And yet, despite the size of this group, many dual-eligible beneficiaries don't fully understand what their combined coverage actually provides, how the two programs divide responsibility for paying their bills, or what plan options exist specifically for them. Getting clarity on these questions can make a real difference in both the quality of care you receive and the out-of-pocket costs you face.

The first thing to understand is how Medicare and Medicaid divide the work. Medicare is always the primary payer for dual-eligible individuals. That means Medicare pays first for medical services, hospital stays, doctor visits, and post-acute care like skilled nursing or home health. Medicaid then wraps around Medicare — it typically covers Medicare premiums (including Part B, which runs $185.00 per month in 2025 for most beneficiaries) and, in most cases, Medicare cost-sharing like deductibles and copays. For people on fixed incomes, having Medicaid cover those Medicare out-of-pocket costs can be financially significant. The Part A inpatient hospital deductible alone is $1,676 per benefit period in 2025 — a cost that Medicaid may absorb entirely for full-benefit dual-eligible individuals.

Not all dual-eligible individuals receive the same level of Medicaid benefits, and this distinction matters enormously. Of the approximately 12 million dual-eligible individuals, 8.6 million are classified as "full-benefit" dual-eligible individuals. This group qualifies for the complete range of Medicaid services that Medicare doesn't cover — most importantly, long-term care (including nursing home stays and home and community-based services), as well as dental care and vision care. These are services that traditional Medicare largely does not cover, making full Medicaid eligibility a substantial safety net. The remaining 3.5 million are "partial-benefit" dual-eligible individuals, who qualify only for help with Medicare premiums and sometimes cost-sharing through what are called Medicare Savings Programs. They do not receive the broader Medicaid benefit package.

The four Medicare Savings Programs — the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualifying Individual (QI) program, and the Qualified Disabled and Working Individuals (QDWI) program — each have different income and asset thresholds and cover different costs. The QMB program is the most comprehensive, covering both Part A and Part B premiums plus cost-sharing. If you're enrolled in QMB, providers are legally prohibited from billing you for Medicare cost-sharing, even if they don't accept Medicaid. Many beneficiaries don't know this rule exists and end up paying bills they legally don't owe. If you're unsure which Medicare Savings Program you might qualify for, your State Health Insurance Assistance Program (SHIP) counselor can walk you through the income limits in your state at no charge.

According to CMS.gov data, the distribution of dual-eligible individuals is far from uniform across the country. Nationally, dual-eligible individuals make up 21% of all Medicare beneficiaries, but in some states that share climbs dramatically. In the District of Columbia, New York, and Connecticut, dual-eligible individuals represent 30% or more of all Medicare beneficiaries. State Medicaid programs set their own eligibility rules within federal minimums, which means income and asset thresholds for Medicaid — and therefore for dual-eligible status — vary significantly depending on where you live. A person who qualifies for full Medicaid benefits in one state might only qualify for a Medicare Savings Program in another. This geographic variation is one reason it's worth checking your specific state's Medicaid rules rather than relying on national averages.

Data Snapshot: According to CMS.gov Medicare-Medicaid linked enrollment data analyzed through 2022 and 2023, dual-eligible individuals represent 21% of total Medicare enrollment nationally but account for a disproportionately large share of combined Medicare and Medicaid spending — driven by per-person costs that substantially exceed those of non-dual-eligible beneficiaries. CMS data also shows that in 2024, there were more than 900 Dual Eligible Special Needs Plans (D-SNPs) available nationally, reflecting significant growth in plan options specifically designed to coordinate care for this population. The average number of D-SNPs available per county has increased steadily over the past five years, giving more dual-eligible beneficiaries access to integrated coverage options than at any prior point in the program's history.

The reason dual-eligible individuals account for such a large share of spending relative to their enrollment numbers comes down largely to health status. This population reports higher rates of fair or poor health, greater need for assistance with activities of daily living such as bathing, dressing, and managing medications, and significantly higher rates of chronic conditions compared to people enrolled in only Medicare or only Medicaid. Analysis of 2022 and 2023 claims data confirms that per-person spending among dual-eligible individuals rises with the number of chronic conditions a person has — meaning the sickest members of this group drive the highest costs. Conditions like diabetes, heart failure, chronic kidney disease, and serious mental illness are all more prevalent in this population, and managing multiple conditions simultaneously requires more care coordination, more specialist visits, and more prescription medications.

For dual-eligible individuals, one of the most important coverage decisions involves whether to enroll in a Dual Eligible Special Needs Plan, commonly called a D-SNP. These are a type of Medicare Advantage plan specifically designed for people who have both Medicare and Medicaid. D-SNPs are required to coordinate with your state's Medicaid program, and many offer additional benefits beyond what standard Medicare Advantage plans provide — things like transportation to medical appointments, over-the-counter allowances, meal delivery after a hospital stay, and expanded dental and vision coverage. Because D-SNPs are Medicare Advantage plans, they replace Original Medicare (Parts A and B) and typically include Part D prescription drug coverage. In 2024, many D-SNPs carried $0 monthly premiums for qualifying enrollees, though the specific benefits and costs vary by plan and county.

One of the persistent challenges for dual-eligible individuals is fragmented care — receiving services from multiple providers across two separate insurance systems that don't always communicate well with each other. A hospitalization covered by Medicare, followed by a nursing home stay covered by Medicaid, followed by home health services that may involve both programs, can create billing confusion, gaps in care transitions, and situations where neither program is clearly responsible. Fully integrated D-SNPs, sometimes called FIDE-SNPs (Fully Integrated Dual Eligible Special Needs Plans), attempt to solve this by placing both Medicare and Medicaid benefits under a single managed care organization. Not every state has FIDE-SNPs available, but where they exist, research suggests they can improve care coordination and reduce unnecessary hospitalizations.

Enrollment rules for dual-eligible individuals are more flexible than for other Medicare beneficiaries. If you qualify for both Medicare and Medicaid, you have a continuous Special Enrollment Period (SEP) that allows you to switch Medicare Advantage or D-SNP plans once per calendar quarter — that's up to three plan changes per year, plus your initial enrollment. This is a significant advantage over standard Medicare Advantage enrollees, who are generally limited to the Annual Enrollment Period (October 15 through December 7) and the Open Enrollment Period (January 1 through March 31). The quarterly SEP exists because dual-eligible individuals' circumstances can change — Medicaid eligibility can shift, plan contracts can change, and care needs evolve. Knowing you have this flexibility means you're not locked into a plan that stops working for you.

If you're currently in Original Medicare with a Medigap supplement and you also have Medicaid, it's worth understanding how those pieces interact. Medigap plans cover Medicare cost-sharing, but if Medicaid is already covering your cost-sharing, you may be paying a Medigap premium for coverage that duplicates what Medicaid provides. Average Medigap Plan G premiums nationally run roughly $100 to $200 per month depending on age and location — money that may not be necessary if Medicaid is already filling those gaps. A licensed Medicare counselor or your state SHIP program can help you evaluate whether your current coverage structure makes financial sense given your Medicaid status.

For family members helping an older parent or spouse navigate dual eligibility, the most important first step is confirming exactly which category of dual-eligible status applies — full-benefit or partial-benefit — and then reviewing what D-SNP options are available in your county. Medicare's Plan Finder tool at Medicare.gov allows you to filter specifically for D-SNPs and compare their benefits, drug formularies, and star ratings side by side. CMS assigns star ratings to Medicare Advantage and D-SNP plans on a 1-to-5 scale based on quality and performance measures; plans rated 4 stars or higher are generally considered strong performers. Choosing a higher-rated D-SNP may mean better care coordination, more responsive customer service, and stronger chronic disease management programs — all of which matter more for dual-eligible individuals than for healthier Medicare beneficiaries.

Finally, if you believe you may qualify for Medicaid but haven't applied, it's worth checking your eligibility even if you were turned down in the past. Medicaid income and asset rules have changed in many states, and the financial thresholds are higher than many people expect. In most states, a single person can qualify for a Medicare Savings Program with monthly income up to roughly $1,500 to $1,700, though exact figures vary by state and program type. Your State Medicaid agency, your local Area Agency on Aging, or a SHIP counselor can help you determine eligibility and assist with the application at no cost to you. For a population that already faces higher health burdens and higher care costs, making sure you're receiving every dollar of coverage you're entitled to is not a small matter — it can be the difference between affording your medications and skipping them.