Medicare & Medicaid
Understanding Your Options When You Have Both
Feeling overwhelmed by Medicare and Medicaid?
You’re not alone.
If you qualify for both Medicare and Medicaid, you might feel stuck trying to figure out what coverage you have, what you still need, or what you can change. The truth is, having both programs—often called being “Dual Eligible”—can be powerful, but only if it’s working for you.
At Mere, we’ve helped thousands of individuals simplify what’s often confusing and make the most of the coverage they already qualify for.
We guide you every step of the way—at no cost to you.
Whether you're already on Medicaid or think you might qualify, we’ll help you:
Understand the difference between Medicare and Medicaid
See if you’re eligible for additional help (like a Dual Special Needs Plan – DSNP or Extra Help/LIS)
Apply or reapply for Medicaid and/or Low-Income Subsidy
Navigate plan options that offer more than Original Medicare and Medicaid alone
Have questions?
Our MereCare Team is here to help you every step of the way—from scheduling your appointment to making sure your enrollment is smooth and stress-free.
What’s the difference between Medicare and Medicaid?
Think of it like this:
Medicare is federal and kicks in first. It’s mainly for people 65+ or under 65 with disabilities. It helps cover hospital stays (Part A), doctor visits (Part B), and can include prescription drugs (Part D).
Medicaid is state-run and helps low-income individuals with things Medicare doesn’t fully pay for—like copays, deductibles, prescriptions, and sometimes even transportation or dental.
When you have both, Medicare pays first, and Medicaid helps pick up the rest.
Why choose a DSNP (Dual Special Needs Plan)?
A DSNP is a Medicare Advantage plan made just for people with Medicare and Medicaid. It may offer:
$0 premiums, copays, or deductibles
Extra benefits like vision, dental, hearing, OTC credits, transportation, and even food/utility cards
One ID card and one coordinated plan for easier use
Without a DSNP, many people just have Original Medicare + Medicaid—but they miss out on helpful extras.
Do you qualify?
You might qualify for full Medicaid or one of the partial programs based on income and assets:
Note: These are estimated national averages and do not reflect every state. Some states do not count certain assets like your home or car. Contact us for help confirming your state’s exact guidelines.
| Program | Monthly Income (Individual) |
Monthly Income (Couple) |
Asset Limit (Individual) |
Asset Limit (Couple) |
|---|---|---|---|---|
| Full Medicaid | Varies by state (typically below $1,255) |
Varies by state (typically below $1,704) |
Up to $2,000 | Up to $3,000 |
| QMB (Qualified Medicare Beneficiary) | Up to $1,275 | Up to $1,724 | Up to $9,430 | Up to $14,130 |
| SLMB (Specified Low-Income Medicare Beneficiary) | $1,276–$1,526 | $1,725–$2,064 | Up to $9,430 | Up to $14,130 |
| QI-1 (Qualifying Individual) | $1,527–$1,715 | $2,065–$2,320 | Up to $9,430 | Up to $14,130 |
Income and asset limits are estimates and vary by state. Some states do not count your home, car, or burial funds. Contact us for personalized help reviewing your eligibility.
Why choose a DSNP (Dual Special Needs Plan)?
A DSNP is a Medicare Advantage plan made just for people with Medicare and Medicaid. It may offer:
$0 premiums, copays, or deductibles
Extra benefits like vision, dental, hearing, OTC credits, transportation, and even food/utility cards
One ID card and one coordinated plan for easier use
Need Help Paying for Prescriptions?
Learn About Extra Help (LIS)
Many people with Medicare qualify for Extra Help—a federal program that reduces your
prescription drug costs. It can lower what you pay at the pharmacy and even eliminate your Part D plan premium or deductible.
If you have both Medicare and Medicaid, or qualify for a Medicare Savings Program like QMB or SLMB, you likely already receive full Extra Help automatically.
But even if you don’t have Medicaid, you may still qualify based on your income and resources. We can help you understand your eligibility and submit the application—at no cost to you.
Frequently Asked Questions (FAQ)
What is the difference between Medicare and Medicaid?
Medicare is a federal health insurance program primarily for people age 65+ or under 65 with disabilities. Medicaid is a state-based program that helps people with low income and resources. If you qualify for both, Medicare pays first, Medicaid helps with the rest.
If I have QMB, SLMB, or QI1 in 2025, can I change my Medicare Advantage Plan (MAPD)?
Not anymore. As of 2025, partial Medicaid programs like QMB, SLMB, and QI1 do not trigger a Special Enrollment Period (SEP) to change your MAPD plan. We can help you review other SEP options if you qualify.
How do I know if I qualify for Medicaid or LIS (Extra Help)?
Eligibility is based on income and resources. We can walk you through a quick screening and help you apply for both Medicaid and LIS at no cost.
What if I’ve lost my Medicaid or was denied?
You still have options. If you’re eligible for Medicare, we can help you review low-cost coverage alternatives or reapply for Medicaid with proper documentation.
Why would I need a Lifeline phone?
Many dual eligible individuals qualify for a free phone through the Lifeline program. If you don’t already have one, we can help you get connected. Visit the Lifeline page here »
I keep seeing commercials, getting phone calls, and mail about “free benefits”—are these real?
Many of the ads, calls, and postcards you receive are targeted at people who have both Medicare and Medicaid (Dual Eligible)—and they often don’t explain that clearly. While some of the benefits they advertise do exist, not everyone qualifies for them.
Unfortunately, many of these messages are designed to get you to switch plans without checking if your doctors and medications are still covered—and that can cause major problems later.
Before you make any changes, talk to a licensed agent who will review your providers, prescriptions, and eligibility first. We're happy to do that for you at no cost.
What is LIS (Extra Help) and how does it work?
Extra Help is a program that helps people with Medicare save money on their Part D prescription drug costs. It can reduce or eliminate premiums, deductibles, and copays—and helps ensure your medications are more affordable year-round.
Do I have to have Medicaid to qualify?
No. While many people with Medicaid automatically get Extra Help, you don’t have to have Medicaid to qualify. If your income and assets fall within certain guidelines, you may still be eligible. We’ll help you find out.
How does Extra Help work with Medicare and Medicaid?
If you have both Medicare and Medicaid, Medicare pays first, and Medicaid helps with costs Medicare doesn’t cover. Extra Help then lowers what you pay for prescriptions through your Part D plan. All three work together to reduce your overall out-of-pocket expenses.
Can you help me apply for Extra Help (LIS)?
Yes! Our team helps you understand your options and apply for programs like LIS—no cost, no pressure. Just reach out and we’ll walk you through it.
We’re here to help—no cost, no pressure, just real answers.
You shouldn’t have to figure this out alone. Let our team help you get the coverage—and the support—you deserve.
This is a solicitation of insurance. A licensed insurance agent with Mere is contracted with multiple carriers offering Medicare Advantage and Prescription Drug Plans. Enrollment depends on contract renewal. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY:1-877-486-2048) to get information on all your options.
This site is owned and operated by Mere, an independent insurance agency. It is not associated with, endorsed by, or authorized by the Social Security Administration, the Department of Health and Human Services, or the Centers for Medicare and Medicaid Services. For official information about Medicare, visit www.medicare.gov.
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