Qualify for Both Medicare
and Medicaid?
You May Be Entitled to
More Benefits Than You Know.

A D-SNP (Dual-Eligible Special Needs Plan) is a type of Medicare Advantage plan built specifically for people who qualify for both Medicare and Medicaid. D-SNPs coordinate your benefits into a single plan, often with one ID card and a care coordinator.

No. Joining a D-SNP does not affect your Medicaid eligibility, which is determined separately by your state. Your Medicaid coverage remains fully intact — a D-SNP simply changes how your Medicare and Medicaid benefits are coordinated and delivered to you.

Income limits vary significantly by state and by program. Full Medicaid income limits are set state by state and vary widely, so a national figure would only mislead you. Medicare Savings Programs generally have higher thresholds than full Medicaid, which is why people who are turned down for one are sometimes approved for the other. Because this varies so much by state, the most accurate way to know if you qualify is to check with your state Medicaid office or speak with a licensed advisor.

Not necessarily. If your income is a bit above the full Medicaid limit, you may still qualify for a Medicare Savings Program (MSP) — a separate set of programs with their own, often higher, income thresholds. There are three main levels: QMB (the most comprehensive — covers your Part B premium plus all deductibles, coinsurance, and copays, for individual income up to roughly $1,350–$1,824/month depending on household size), SLMB (covers just your Part B premium, up to roughly $1,616–$2,184/month), and QI (also covers just the Part B premium, for slightly higher incomes still, up to roughly $1,816–$2,455/month — though QI has limited annual funding and must be reapplied for each year). All three automatically qualify you for Extra Help with prescription costs. It's always worth applying even if you think you're slightly over a limit, since several states use more generous rules than the federal minimums. Learn more about Medicare Savings Programs →

Many full dual-eligible individuals can use a monthly Special Enrollment Period to switch to an integrated D-SNP, rather than waiting for the standard Annual Enrollment Period. This flexible window was introduced specifically to make coordinated care easier to access. Whether you qualify for this monthly SEP depends on your specific dual-eligible status.

Extra Help is a federal program that significantly lowers Medicare Part D prescription drug costs. If you qualify for full Medicaid, you automatically qualify for full Extra Help — no separate application needed. If you don't have full Medicaid but have limited income and resources, you may still qualify for Extra Help by applying separately through Social Security.

Step one is applying for Medicaid through your state — and it's simpler than most people expect. Medicaid is administered at the state level, so the process varies slightly by state, but the starting point is the same: you can apply online through your state's Medicaid agency website, by phone, or in person at your local Department of Human Services or benefits office. In Arkansas, that's medicaid.mmac.ar.gov. You can also apply through healthcare.gov, which screens for Medicaid eligibility automatically.

You'll typically need to provide proof of income, residency, identity, and — for some programs — asset information. Most applications are processed within 45 days, though many states act faster.

Once you have Medicaid, here's how a D-SNP works: You need Medicaid in place first before you can enroll in a D-SNP — the plan requires active Medicaid enrollment to qualify. Once you're confirmed as dual-eligible, a PharmSurance advisor can check which D-SNP plans are available in your specific county, compare their benefits, and walk you through enrolling. Many fully dual-eligible individuals also have a monthly Special Enrollment Period, meaning you don't have to wait for October to make the switch. The process is straightforward — and our advisors handle it with you at no cost.

The only way to know for certain is to apply — and there's no penalty for applying and being turned down. Medicaid income and resource limits are higher than most people expect, and many individuals who assume they won't qualify are surprised to find that they do. Several factors affect eligibility beyond income alone: household size, medical expenses, disability status, and state-specific rules all play a role.

Even if you don't qualify for full Medicaid, you may still qualify for a Medicare Savings Program — a federal program that helps pay your Medicare premiums and potentially other costs, with income thresholds significantly higher than Medicaid. A PharmSurance advisor can walk through your situation and help you understand which programs you may be eligible for before you apply.