Medicare
Dual Eligible
Dual-eligible beneficiaries receive Medicare for primary coverage and Medicaid for cost-sharing assistance, long-term care, and services Medicare does not cover.
Last reviewed: May 2026 · Editorial methodology
Definition
Dual-eligible individuals are Medicare beneficiaries who also qualify for Medicaid, the joint federal-state program for low-income individuals. There are approximately 12 million dual-eligible beneficiaries in the United States as of 2026, representing the most medically complex and costly population in the Medicare program. Full dual eligibles receive both Medicare and full Medicaid benefits, with Medicaid typically covering Medicare premiums and cost-sharing plus additional services like long-term care, personal care assistance, and non-emergency medical transportation. Partial dual eligibles receive Medicaid assistance only for Medicare premiums or cost-sharing through one of the Medicare Savings Programs. Dual-eligible beneficiaries automatically qualify for Extra Help with Part D drug costs. CMS offers Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan specifically designed to coordinate Medicare and Medicaid benefits for this population with specialized care management. D-SNPs are required to align benefits, cost-sharing, and member experience with Medicaid programs in their state.
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Cover Forge USA Editorial Team
Editorial Lead
This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.
Reviewed 2026-06-14
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