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.

Where this term matters

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Tip

Glossary definitions are educational. Always check your own policy language — insurers can define common terms differently from one another. When in doubt, request a written explanation from your agent.

Related terms

QMB (Qualified Medicare Beneficiary)QMB status eliminates virtually all Medicare out-of-pocket costs for qualifying beneficiaries and providers cannot bill QMB-enrolled patients for cost-sharing.SLMB (Specified Low-Income Medicare Beneficiary)SLMB covers the monthly Part B premium for qualifying low-income Medicare beneficiaries whose income exceeds the QMB limit but remains below 120% of FPL.Extra Help (Low-Income Subsidy)Extra Help (also called the Low-Income Subsidy or LIS) dramatically lowers prescription drug costs for Medicare beneficiaries with limited income and resources.Medicare Savings ProgramsMedicare Savings Programs can eliminate Part B premiums and reduce other Medicare cost-sharing for qualifying low-income individuals.Medicare Part C (Medicare Advantage)Medicare Advantage plans deliver all Original Medicare benefits through private insurers and frequently include prescription drug coverage, dental, vision, and hearing benefits.

Related guides

Source: Cover Forge USA editorial team|Last verified: May 2026|Methodology
Definitions are educational and may be simplified. Always refer to your policy contract and consult a licensed agent for terms that affect coverage decisions.
CF

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 June 2026

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