Last verified: March 2026. These figures may have changed. Check your state Medicaid agency for the most current details.
A dual eligible individual is someone enrolled in both Medicare and Medicaid at the same time. The dual eligible definition applies to approximately 13.6 million Americans, including about 7.2 million low-income seniors and 4.8 million people with disabilities. Medicare covers hospital stays, doctor visits, and medical equipment. Medicaid fills the gaps, paying for services like long-term care, dental, and transportation. If you're helping a parent or spouse figure out their coverage, you can chat with Brevy to check eligibility in a few minutes.
Why Dual Eligibility Matters
Dual eligibility can sharply reduce out-of-pocket healthcare costs. For full-benefit dual eligibles, Medicaid pays Medicare premiums and cost-sharing. It also covers services Medicare doesn't: long-term services and supports, nursing facility care beyond 100 days, dental, vision, hearing, and transportation.
All dual eligibles automatically qualify for Extra Help, which reduces prescription drug costs under Medicare Part D to a maximum of $12.65 per drug in 2026. When both programs cover the same service, Medicare pays first and Medicaid covers the difference.
Despite making up only 20% of Medicare beneficiaries, dual eligibles account for 36% of Medicare spending. Combined Medicare and Medicaid spending on this group totaled $548.8 billion in calendar year 2022. That spending reflects the population's higher rates of chronic conditions, disabilities, and long-term care needs.
Not sure if you qualify? Chat with Brevy to check your eligibility -- it takes a few minutes.
Full vs. Partial Dual Eligible Definition
CMS defines seven dual eligibility categories, split into two groups: full-benefit and partial-benefit.
Full-benefit dual eligibles qualify for Medicare and the full range of Medicaid benefits in their state. As of calendar year 2022, 74% of all dual eligibles (approximately 10.1 million people) had full-benefit status.
Partial-benefit dual eligibles get help paying Medicare costs but don't qualify for full Medicaid benefits. About 26% of dual eligibles (approximately 3.5 million people) were partial-benefit in calendar year 2022.
2026 Income and Asset Limits
| Category | Benefit Level | Individual Income | Individual Assets | What Medicaid Covers |
|---|---|---|---|---|
| QMB | Full or Partial | Up to $1,350/mo | $9,950 | Part A/B premiums + cost-sharing |
| SLMB | Full or Partial | Up to $1,616/mo | $9,950 | Part B premium |
| QI | Partial only | Up to $1,816/mo | $9,950 | Part B premium |
| QDWI | Partial only | Up to $5,405/mo | $4,000 | Part A premium |
Some states don't count assets when determining eligibility for these programs. Income limits include a standard $20 disregard, and states can set their thresholds above the federal floor.
Important: The figures above are 2026 federal minimums from CMS. Your state may use higher income limits or waive asset tests. Contact your state Medicaid office to verify current requirements for your situation.
Want to see if your family is eligible? Start a free eligibility check with Brevy -- no paperwork needed.
Examples
Here's what dual eligibility looks like in practice:
- Full-benefit (QMB Plus): A senior with income under 100% of the federal poverty level qualifies for both Medicare and full Medicaid. Medicaid pays all Medicare premiums, deductibles, and copays. Doctors can't bill this person for any Medicare cost-sharing. They also receive dental, vision, and long-term care coverage through Medicaid.
- Partial-benefit (SLMB Only): A Medicare beneficiary with income between 100% and 120% of the federal poverty level gets their Part B premium paid by Medicaid. They don't get full Medicaid benefits and still pay their own Medicare deductibles and copays.
- Partial-benefit (QI): Someone with income between 120% and 135% of the federal poverty level receives Part B premium help only. QI is funded through annual federal allotments, so states approve applications on a first-come, first-served basis.
Many families don't realize their parent qualifies until they sit down and check the income limits. The application for Medicare Savings Programs is separate from regular Medicare enrollment, and that's where eligible people often fall through the cracks.
Common Misconceptions
Do all dual eligibles get the same benefits?
No. Benefits depend entirely on your category. Full-benefit dual eligibles receive the full range of Medicaid services. Partial-benefit dual eligibles only get help with Medicare premiums and, in some categories, cost-sharing.
Can doctors bill QMB patients for Medicare copays?
No. All Medicare providers are prohibited from billing QMB patients for any Part A or Part B cost-sharing, even if the provider doesn't accept Medicaid. Providers who bill QMBs improperly must refund the amount and can face sanctions.
Have questions about your situation? Ask Brevy -- it's free and takes a few minutes.
Related Terms
- Medicare Savings Programs (MSPs): State Medicaid programs that help pay Medicare premiums and cost-sharing. QMB, SLMB, QI, and QDWI are all MSPs.
- Extra Help (Low Income Subsidy): A federal program that reduces Medicare Part D prescription drug costs. All dual eligibles qualify automatically.
- D-SNP (Dual Eligible Special Needs Plan): A type of Medicare Advantage plan designed to coordinate Medicare and Medicaid benefits through one managed care plan.
- HCBS (Home and Community-Based Services): Medicaid-funded services that help people live at home instead of in a nursing facility. Available to full-benefit dual eligibles.
Sources
- CMS, Dual Eligibility Categories (revised February 2026)
- MedPAC/MACPAC, Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid (December 2025)
- CMS, Beneficiaries Dually Eligible for Medicare and Medicaid
- Medicaid.gov, Seniors & Medicare and Medicaid Enrollees
- Medicare.gov, Medicare Savings Programs (2026)
- NCOA, What Does It Mean to Be Dual Eligible for Medicare and Medicaid?
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.