Dual-Eligible Checker
Find out if you're 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: full dual eligible, with complete Medicaid benefits including long-term care, and partial dual eligible, with help paying Medicare premiums through a Medicare Savings Program but not full Medicaid coverage.
Many people don't realize dual eligibility comes in two different levels with very different benefits. Answer a couple of questions below to see which category applies to you, and what it means for your coverage.
Check Your Dual-Eligible Status
Full dual eligibility is the more comprehensive status: complete Medicaid benefits on top of Medicare, which matters most for things Medicare doesn't cover well, like extended long-term care. Full duals also get automatically enrolled in Extra Help, lowering their Part D drug costs, without a separate application. Partial dual eligibility is narrower. It means you're enrolled in a Medicare Savings Program, QMB, SLMB, or QI, which helps with Medicare premiums and, for QMB specifically, cost-sharing too, but doesn't extend to full Medicaid benefits. Both groups may be eligible for a D-SNP, a Dual Eligible Special Needs Plan, a specific type of Medicare Advantage plan built to coordinate Medicare and Medicaid benefits together rather than treating them as separate systems. If you have Medicare and a limited income but aren't sure whether you have Medicaid or a Medicare Savings Program, it's worth checking both directly, since a meaningful number of people who'd qualify never apply.
Frequently Asked Questions
What does "dual eligible" mean?
Being enrolled in both Medicare and Medicaid at the same time. There are two levels: full dual eligible, with complete Medicaid benefits, and partial dual eligible, with help through a Medicare Savings Program but not full Medicaid.
What's the difference between full and partial dual eligibility?
Full dual eligibles get complete Medicaid benefits, including things Medicare doesn't cover like most long-term care. Partial dual eligibles only get help with Medicare premiums, and for QMB specifically, cost-sharing too, through a Medicare Savings Program.
What is a D-SNP?
A Dual Eligible Special Needs Plan, a type of Medicare Advantage plan designed specifically for dual-eligible beneficiaries, coordinating Medicare and Medicaid benefits together.
Do full dual eligibles automatically get Extra Help for prescription drugs?
Yes. Full dual eligibility comes with automatic enrollment in Extra Help, the Part D Low-Income Subsidy, without a separate application.
Can I be dual eligible without realizing it?
Not exactly, since Medicaid and Medicare Savings Programs require an application, but many people who would qualify never apply. If you have Medicare and limited income, it's worth checking.
Do I need Medicare before I can be dual eligible?
Yes. Dual eligibility requires enrollment in both programs, so Medicare eligibility is a prerequisite.
This tool provides a general status check based on your stated Medicare and Medicaid coverage and does not verify your actual enrollment or determine eligibility. For an official determination of your dual-eligible status, contact the Social Security Administration or your state Medicaid agency.