12 million Americans have both Medicare and Medicaid coverage. This is known as being “dual eligible,” meaning they get benefits from both programs to help pay healthcare costs.1

Let’s take a look at Medicare and Medicaid, how to qualify for dual eligibility and more.

What is Medicare and Medicaid?

These programs may sound the same, but they’re different in many ways.

Medicare

Medicare is our country’s federal health insurance program. There are 4 different parts of Medicare that help cover specific services:


Eligibility requirements for Original Medicare Parts A and B include:

  • Age 65 or older
  • Younger than 65 with a qualifying disability
  • Living with ESKD (end-stage kidney disease), permanent kidney failure requiring dialysis or a kidney transplant

Medicaid

Medicaid is an assistance program provided jointly by federal and state agencies. It helps with medical expenses for eligible people with limited income and resources.

There are different rules for each state, but in most states, you may be eligible for Medicaid if you are under certain income levels and/or are:

  • Age 65 and older
  • A child under age 19
  • Pregnant
  • Living with a disability
  • A parent or adult caring for a child
  • An adult with dependent children
  • An eligible immigrant

What does dual eligibility mean?

People who qualify for both Medicare and Medicaid are called “dual eligible.” If you’re dual eligible, your Medicaid and Medicare plan(s) will work together to provide coverage for your needs. In most cases, Medicare will be your primary plan and cover most Medicare-eligible healthcare services. Medicaid is typically the secondary plan and may cover medical costs that Medicare doesn't cover or partially covers.

How do I qualify for dual eligibility?

To qualify for dual eligibility, you must meet the requirements for both Medicare and Medicaid and be enrolled in both programs.

For enrollment information, check out these resources:

Benefits of dual eligibility

Being dual eligible can provide greater healthcare coverage. Medicaid also covers some expenses that Medicare does not, such as long-term nursing home care and personal care services.

Some other potential items and services covered by dual eligibility include:

What is covered by Medicaid and Medicare?

Medicaid plans offer different optional benefits from state to state. However, it’s mandatory for all Medicaid plans to include inpatient and outpatient hospital services, physician services, laboratory and x-ray services and home health services.2

For information on Medicare, check out what Medicare covers (and doesn’t cover).

Frequently asked questions about Medicare and Medicaid

1. How often can I change my Medicare Advantage Special Needs plan with dual eligibility?

2. Who pays first if I have dual eligibility (Medicare or Medicaid)?

Medicare is the primary payer and pays its portion first. Medicaid is the secondary payer and pays any remaining costs for items and services it covers.3

3. Can I select the plan I want for Medicare and Medicaid?

If you’re eligible for Original Medicare, you’ll be automatically enrolled in Part A (Hospital Insurance) and Part B (Medical Insurance). It’s your decision to join a Part C (Medicare Advantage) or Part D (prescription drug coverage) plan. If you’re eligible for Medicaid, the opportunity to select a plan can vary from state to state.

Humana answers your Medicare questions

How can we help?

Call us

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1-888-204-4062 (TTY: 711)

See plans in your area

Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies.

Request a call

Our licensed Humana sales agents are available to help you select the coverage that best meets your needs.

Sources

  1. “Seniors & Medicare and Medicaid Enrollees,” Medicaid.gov, last accessed July 10, 2023, https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html.
  2. “Benefits,” Medicaid.gov, last accessed July 10, 2023, https://www.medicaid.gov/medicaid/benefits/index.html.
  3. “What Is a Dual Eligible Special Needs Plan (D-SNP)?,” National Council on Aging, last accessed July 10, 2023, https://ncoa.org/article/what-is-a-dual-eligible-special-needs-plan-d-snp.