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Dual Eligibility for Medicare and Medicaid in 2027: Who Qualifies and What You Get

By Brian Monahan Updated October 17, 2026

Reviewed October 17, 2026. You’re dual eligible if you have Medicare and also qualify for Medicaid, either full Medicaid benefits or a Medicare Savings Program that helps pay Medicare premiums and cost sharing. About 12.5 million people were dual eligible on average in fiscal year 2025, according to CMS. Duals automatically get Extra Help with Part D drug costs and can join a Dual Eligible Special Needs Plan (D-SNP) that coordinates both programs.

Quick answer: To become dual eligible, apply for Medicaid or a Medicare Savings Program through your state Medicaid agency. In 2026 the Qualified Medicare Beneficiary (QMB) program has an income limit of $1,350 a month for an individual ($1,824 for a couple) and a resource limit of $9,950 ($14,910 for a couple); some states are more generous. For 2027, Extra Help caps drug copays at $5.80 for generics and $14.40 for brand-name drugs, and $0 once drug costs reach $2,400.

What does dual eligible mean?

CMS splits dual eligibles into two groups (CMS: Dual eligibility categories):

Full-benefit duals have Medicare plus full Medicaid benefits (QMB Plus, SLMB Plus and other full-benefit duals). Medicaid can cover services Medicare doesn’t, such as long-term nursing home care and, in many states, dental and vision.
Partial-benefit duals have Medicare and a Medicare Savings Program only (QMB only, SLMB only, QI or QDWI). Medicaid helps with Medicare costs but doesn’t add other benefits.

CMS reports that about 72% of dual eligibles have full benefits and 28% have partial benefits. (CMS Medicare-Medicaid Coordination Office, FY2025 report) For a side-by-side of the two programs, see Medicaid vs Medicare.

Medicare Savings Programs: what each pays and 2026 limits

Program	What it pays	2026 monthly income limit (individual / couple)	2026 resource limit (individual / couple)
QMB	Part A and B premiums, deductibles, coinsurance and copays	$1,350 / $1,824	$9,950 / $14,910
SLMB	Part B premium	$1,616 / $2,184	$9,950 / $14,910
QI	Part B premium (reapply yearly; first come, first served)	$1,816 / $2,455	$9,950 / $14,910
QDWI	Part A premium for certain working people with disabilities	$5,405 / $7,299	$4,000 / $6,000

Source: Medicare.gov: Medicare Savings Programs. Limits are slightly higher in Alaska and Hawaii, and some states don’t count certain income or resources. 2027 limits haven’t been published yet.

The Part B premium these programs pay is $202.90 a month in 2026, with a $283 deductible. CMS hasn’t announced 2027 Part B amounts yet; it usually does in November. (CMS 2026 fact sheet)

QMB billing protection: CMS prohibits Medicare providers, including pharmacies, from billing people in the QMB program for Medicare deductibles, coinsurance or copays. Show both your Medicare card and your Medicaid or QMB card at every visit. (CMS: QMB program)

Extra Help with drug costs: 2026 vs 2027

If you have full Medicaid, a Medicare Savings Program or SSI, you get Extra Help automatically. (Medicare.gov: Extra Help)

	2026	2027
Generic copay (most Extra Help enrollees)	Up to $5.10	Up to $5.80
Brand-name copay	Up to $12.65	Up to $14.40
Full duals at or below 100% of poverty	$1.60 generic / $4.90 brand	Up to $4.90 per drug (full Medicaid + QMB, per Medicare.gov)
Full duals in a nursing home or getting HCBS	$0	$0
Part D out-of-pocket cap (all enrollees)	$2,100, then $0	$2,400, then $0

Sources: CMS 2026 LIS memo; Medicare.gov; Medicare.gov Part D costs.

People without Medicaid can still apply for Extra Help through Social Security if their 2026 income is under $23,940 ($32,460 for a couple) and resources are under $18,090 ($36,100). (SSA publication EN-05-10508) For drug-specific questions, see what Medicare Part D covers.

D-SNPs for dual eligibles in 2027

A Dual Eligible Special Needs Plan is a Medicare Advantage plan for people with both Medicare and Medicaid. Every D-SNP must have a contract with the state Medicaid agency. (CMS: D-SNPs) D-SNPs often include extras like OTC allowances, dental and vision. Some are “integrated” (FIDE SNPs, HIDE SNPs or applicable integrated plans) and coordinate Medicaid benefits through the same company; learn more in HIDE SNPs and FIDE SNPs explained.

When can dual eligibles change plans?

Open Enrollment: October 15 to December 7, 2026, for coverage starting January 1, 2027.
Monthly dual/LIS SEP: since January 1, 2025, duals and Extra Help enrollees can switch to Original Medicare with a stand-alone drug plan, or change drug plans, once a month. It replaced the old quarterly SEP.
Integrated care SEP: full-benefit duals can join a FIDE SNP, HIDE SNP or applicable integrated plan once a month.

Neither monthly SEP lets you switch into a regular (non-D-SNP) Medicare Advantage plan. Changes take effect the first day of the next month. (CMS SEP job aid, Medicare.gov SEPs)

What changes for D-SNPs in 2027

Starting in 2027, where a company offers both a D-SNP and a Medicaid managed care plan for full-benefit duals in the same area, it can offer only one D-SNP for full-benefit duals there, and new enrollment is limited to people who are in (or joining) the company’s Medicaid plan. From 2030, those D-SNPs can only keep or enroll members in the affiliated Medicaid plan. (CMS 2027 FAQ on 42 CFR 422.514(h)) If your D-SNP’s Annual Notice of Change says your plan is changing or ending, compare options during Open Enrollment.

What dual eligibles get

Lower Medicare costs: premiums and, for QMB, deductibles and copays paid by Medicaid.
Extra Help: low, fixed drug copays.
Medicaid services (full duals): long-term care, such as nursing home care and memory care, personal care and, depending on the state, vision and dental benefits.
Plan choice: D-SNPs and monthly enrollment chances.

Common challenges include keeping Medicaid at renewal time and finding providers who accept both programs. Read how Medicaid renewal works so you don’t lose coverage, and confirm a doctor takes both Medicare and your state’s Medicaid before you book.

How to apply for dual eligibility

Apply for Medicaid or a Medicare Savings Program with your state Medicaid agency; Medicaid.gov lists every state’s contact. (Medicaid.gov) Medicare.gov encourages you to apply even if you think you’re over the limits.
Apply for Extra Help through Social Security online, by calling 1-800-772-1213 (TTY 1-800-325-0778) or at a local office, if you don’t get it automatically. (SSA: Extra Help)
Check your status once approved; see how to check your Medicaid status.
Get free counseling from your State Health Insurance Assistance Program (SHIP), or call 1-800-MEDICARE (1-800-633-4227).

Under 65 with a disability? See Medicare for people with disabilities.

Frequently asked questions

How do I know if I’m dual eligible?

If you have Medicare and a Medicaid card, or a notice approving you for QMB, SLMB, QI or QDWI, you’re dual eligible. Your state Medicaid agency can confirm your category.

What is the income limit for dual eligibility in 2026?

It depends on the program. QMB is $1,350 a month for an individual, SLMB $1,616 and QI $1,816, with a $9,950 resource limit. Full Medicaid limits are set by each state.

Do dual eligibles pay a Part B premium?

Usually not. QMB, SLMB and QI pay the Part B premium ($202.90 a month in 2026), and full-benefit Medicaid generally covers it too.

Can dual eligibles change Medicare plans any time?

Not any time, but once a month: you can switch to Original Medicare with a drug plan or change drug plans, and full duals can join an integrated D-SNP. Other changes wait for Open Enrollment.

Is a D-SNP required for dual eligibles?

No. You can keep Original Medicare with a Part D plan and Medicaid, or choose a D-SNP if one fits your doctors and needs.

This article is general information. Medicare365 is an independent website and is not affiliated with Medicare, Medicaid, CMS or any insurance carrier. Rules and limits vary by state.