Who Is Eligible for Both Medicare and Medicaid? (Is It You?)

People may qualify for both Medicare and Medicaid if they meet certain age, health, and income requirements. While Medicare generally covers individuals age 65 and older or those with specific disabilities, Medicaid eligibility is based primarily on income and state guidelines. This article explains who is eligible for both Medicare and Medicaid, often called “dual eligibles,” and what factors determine their qualification.

1. What’s the Difference Between Medicare and Medicaid? 

Medicare vs Medicaid are both government programs that help people pay for health care. The main difference between these programs is that they serve different groups and have different eligibility rules. 

• Medicare is a federal program that provides health insurance mainly for people aged 65 and older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease). 
• Medicaid, on the other hand, is a joint federal and state program that helps with health care costs for people with limited income and resources.  

Medicaid eligibility is based primarily on income and varies by state. Medicaid may offer coverage that Medicare doesn’t typically include, like long-term nursing home care and personal care services. 

Medicare is mainly age- or disability-based, while Medicaid is income-based.

2. Who Is Eligible for Both Medicare and Medicaid? 

Many people qualify for both Medicare and Medicaid. An individual who is eligible for both Medicare and Medicaid programs is said to be a “dual eligible” or “dually eligible”. Being dually eligible means you receive benefits from both programs. 

Dual eligibility is divided into several categories, each with different qualifications and levels of assistance for Medicare costs: 

Qualified Medicare Beneficiaries (QMBs): 

• Income at or below 100% of the Federal Poverty Level (FPL) 
• Meet resource limits  
• Medicaid pays Medicare Part A and B premiums and cost-sharing 
• Providers cannot bill QMBs for deductibles, coinsurance, or copays 

Specified Low-Income Medicare Beneficiaries (SLMBs): 

• Income between 100% and 120% of the FPL 
• Medicaid helps pay Medicare Part B premiums only 

Qualifying Individuals (QIs): 

• Income ranging from 120% to 135% of the Federal Poverty Level (FPL) 
• Receive assistance with Medicare Part B premiums 
• Assistance depends on state funding availability 

Qualified Disabled and Working Individuals (QDWIs): 

• Individuals who lost premium-free Part A after returning to work 
• Income up to 200% of the FPL 
• Medicaid pays Medicare Part A premiums 

Full-benefit Medicaid Recipients: 

• Eligible for full Medicaid benefits in addition to Medicare Part A and/or B 
• Medicaid covers premiums, cost-sharing, and a wide range of health services 

Eligibility is determined by income and asset limits, which differ from state to state. Also, eligibility groups like Medicare Savings Programs (MSPs) help low-income Medicare beneficiaries afford coverage.

>>> Also read: What Is The Difference Between Medicare And Medicaid?

3. How Does Medicare and Medicaid Coverage Work for Dual Eligibles? 

For individuals who qualify for both Medicare and Medicaid (dually eligible beneficiaries), the two programs work together to help cover a wide range of healthcare needs. When someone is dually eligible: 

• Medicare always pays first for services that it covers, such as hospital stays (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D). 
• Medicaid covers some or all of the remaining costs not paid by Medicare, such as copayments, coinsurance, and deductibles. 

For prescription drugs, once you’re found to be dually eligible, you’re automatically enrolled in a Medicare drug plan (Part D). However, Medicaid might still cover some drugs that your Medicare drug plan doesn’t. 

Not all dual eligibles receive the same level of assistance. Different dual eligibility categories define how much assistance a person receives with Medicare premiums, deductibles, copays, and other costs.  

These categories are based on income, assets, and the type of Medicaid coverage they qualify for.  

Check Section 2 again for detailed information on the levels of assistance in each dual eligibility category.

4. What Is the Lifeline Program? 

The Lifeline program is a federal government initiative that helps low-income individuals and families afford essential communication services like phone and internet.  

Lifeline Benefits 

Eligible customers can save up to $9.25 per month on their phone bills. For Tribal citizens, the discount is at $34.25 per month. Besides, Lifeline providers often offer free cell phones, including popular brands such as Samsung and Apple. 

With the Affordable Connectivity Program (ACP) ending in 2024, Lifeline has become the primary federal assistance program helping low-income households maintain affordable phone and internet access. 

Lifeline and Medicaid 

Many people who qualify for Medicaid may also be eligible for the Lifeline program. In fact, Medicaid is the most common way to prove Lifeline eligibility; individuals who qualify for Lifeline through Medicaid make up the largest group of participants in the program.  

If you or someone in your household participates in Medicaid, you or they’re very likely to qualify for Lifeline and get a free device from a specific Lifeline provider like AirTalk Wireless. 

Step 1: Visit the AirTalk Wireless Website 

Go to AirTalk Wireless. Enter your ZIP code.

Step 2: Choose a Lifeline Plan 

AirTalk offers several Lifeline plans: 

• Standard, Plus, Premium, or Unlimited Plans – Include a free phone, and higher-tier plans may have a small monthly fee for extra data. 
• Data Boost Plan (BYOD) – For users who already have a compatible device. This plan provides high-data access without offering a new phone. 

 (Plan and data caps may vary by state.)

Step 3: Pick Your Free Phone (If Needed)

You can select from a range of free phones. If you prefer, upgrade to a higher-end model or get a tablet at a discounted rate or no cost. Offers and prices vary depending on the state and the availability of inventory.

Step 4: Upload Your Documents (If Required) 

Some applicants may need to provide documents to prove eligibility. Some users may be verified automatically.

Make sure you have valid Medicaid documentation in case you are required to submit proof.

Step 5: Submit Your Application

Submit your application. If approved, you’ll receive a confirmation email.

Conclusion 

Eligibility for both Medicare and Medicaid depends on a combination of age, health status, income, and state-specific rules. It’s important to apply within the appropriate enrollment periods and verify eligibility to maximize benefits.

>>> Also read: Free Government iPhone with Medicaid: How To Qualify And Apply