Dual-Eligible Checker
Find out whether you are a full or partial dual-eligible beneficiary and what that means for your Medicare and Medicaid coverage.
Dual eligible means you have both Medicare and Medicaid. There are two levels. A full dual eligible has complete Medicaid benefits, including long-term care. A partial dual eligible gets help with Medicare costs through a Medicare Savings Program but does not have full Medicaid coverage.
The two levels of dual eligibility come with very different benefits. Answer two questions below to see which applies to you and what it means for your coverage.
Check Your Dual-Eligible Status
| Full dual eligible | Partial dual eligible | |
|---|---|---|
| What you have | Medicare and full Medicaid | Medicare and a Medicare Savings Program (QMB, SLMB or QI) |
| Medicare premiums | Usually paid for you | Part B premium paid for you |
| Medicare deductibles and copays | Usually covered | Covered only under QMB |
| Long-term care and other Medicaid services | Covered | Not covered |
| Extra Help with drug costs | Automatic | Automatic |
| Changing plans during the year | Monthly, to Original Medicare or to an integrated D-SNP | Monthly, to Original Medicare only |
Full dual eligibility. You have complete Medicaid benefits in addition to Medicare. Medicaid pays for things Medicare covers poorly or not at all, above all long-term care. Medicare pays first and Medicaid pays second.
Partial dual eligibility. You are enrolled in a Medicare Savings Program. It pays your Part B premium, and under QMB your Medicare deductibles and copays as well. It does not include other Medicaid benefits.
D-SNPs. A Dual Eligible Special Needs Plan is a Medicare Advantage plan that coordinates Medicare and Medicaid benefits. Full duals can generally join one, and partial duals can in some states. The plans differ in how closely they combine the two programs. See D-SNP types and enrollment rules.
If you have Medicare and a limited income and are not sure whether you have Medicaid or a Medicare Savings Program, check both with our Medicaid eligibility calculator and Medicare Savings Program calculator. Many people who qualify never apply.
Frequently Asked Questions
What does "dual eligible" mean?
It means being enrolled in Medicare and Medicaid at the same time. A full dual eligible has complete Medicaid benefits. A partial dual eligible gets help through a Medicare Savings Program without full Medicaid.
What's the difference between full and partial dual eligibility?
Full dual eligibles have complete Medicaid benefits, including services Medicare does not cover, such as most long-term care. Partial dual eligibles get help with Medicare premiums through a Medicare Savings Program, and under QMB with deductibles and copays too.
What is a D-SNP?
A Dual Eligible Special Needs Plan. It is a type of Medicare Advantage plan for dual-eligible beneficiaries that coordinates Medicare and Medicaid benefits.
Do full dual eligibles automatically get Extra Help for prescription drugs?
Yes. Full dual eligibles are enrolled automatically in Extra Help, the Part D Low-Income Subsidy, with no separate application.
Can I be dual eligible without realizing it?
Medicaid and Medicare Savings Programs both require an application, so you would normally know. Many people who would qualify have never applied. If you have Medicare and a limited income, check.
Do I need Medicare before I can be dual eligible?
Yes. Dual eligibility means enrollment in both programs, so you have to have Medicare.
This tool gives a general status check based on the Medicare and Medicaid coverage you report. It does not verify your enrollment or determine eligibility. For an official answer on your dual-eligible status, contact the Social Security Administration or your state Medicaid agency.