Seniors & Medicare & Medicaid
Enrollees
Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare. Medicaid also provides coverage to 4.8 million people with disabilities who are enrolled in Medicare. In total, 12 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 15% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.
What Medicaid Covers for Medicare Enrollees
Medicare has four basic forms of coverage:
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Part A: Pays for hospitalization costs
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Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
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Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
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Part D: Assists with the cost of prescription drugs
Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).
Full Medicaid Benfits also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids.
Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit.
How to qualify for the 4 Medicare Savings Programs (MSP)
2026 Dual Eligible Standards
(Based on Percentage of Federal Poverty Level)
Qualified Medicare Beneficiary (QMB):
Helps pay for: Part A premiums (if you don't have premium-free Part A); Part B premiums, deductibles, coinsurance, and copayments (for services and items Medicare covers).
Monthly Income Limits: (100% FPL + $20)*

If you qualify for the QMB program:
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Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. What should I do if I get a bill?
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You may get a bill for a small Medicaid copayment, if one applies.
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You'll also get Extra Help paying for your prescription drugs. You’ll pay no more than $12.65 in 2026 for each drug covered by your Medicare drug plan.
Specified Low - Income Medicare Beneficiary (SLMB):
Helps pay for: Part B premiums (You must have both Part A and Part B to qualify.)
Monthly Income Limits: (120% FPL + $20)*

If you qualify for the SLMB Program:
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You’ll also get Extra Help paying for your prescription drugs.
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You’ll pay no more than $12.65 in 2026 for each drug your Medicare drug plan covers.
Qualifying Individual (QI):
Helps pay for: Part B premiums (You must have both Part A and Part B to qualify.)
Monthly Income Limits: (135% FPL + $20)*

If you qualify for the QI program:
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You must apply every year to stay in the QI Program.
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States approve applications on a first-come, first-served basis – priority is given to people who got QI benefits the previous year.
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You’ll also get Extra Help paying for your prescription drugs. You’ll pay no more than $12.65 in 2026 for each drug your Medicare drug plan covers
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QI is only available for people who don't qualify for any other Medicaid coverage or benefits, but you may qualify for help from another Medicare Savings Program.
Qualified Disabled Working Individual (QDWI):
Helps pay for: Part A premiums only
Monthly Income Limits: (200% FPL + $20)*
(Figures include additional earned income disregards)

You may qualify for the QDWI Program if you:
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Have a disability
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Are working
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Lost Your Social Security disability benefits and Medicare premium-free Part A because you returned to work


