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Medicare vs Medicaid: Dual Eligibility Explained
The difference
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | Federal government | Each state with federal funding (Texas HHS in Texas) |
| Who qualifies | People 65+, and some younger people with disabilities or ESRD | People with limited income and resources, based on state rules |
| Costs | Premiums, deductibles and coinsurance | Little or no cost for covered services |
| Long-term care | Limited (short skilled nursing stays) | Can cover long-term nursing home care for those who qualify |
Being dual eligible
If you qualify for both, Medicare pays first and Medicaid can help pay what Medicare does not, including premiums and cost sharing. Dual eligible people automatically get Extra Help with drug costs.
QMB protections
If you are in the QMB program, Medicare providers are not allowed to bill you for Medicare-covered services, including deductibles, coinsurance and copays. Show both your Medicare and Medicaid (or QMB) cards. See Medicare Savings Programs in Texas.
Dual Special Needs Plans (D-SNP)
D-SNPs are Medicare Advantage Plans for people with both Medicare and Medicaid. They coordinate both sets of benefits and always include drug coverage. See Medicare Special Needs Plans.
Frequently asked questions
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance mainly for people 65 and older. Medicaid is a state and federal program for people with limited income and resources.
Can I have both Medicare and Medicaid?
Yes. People who qualify for both are called dual eligible. Medicare pays first and Medicaid helps with remaining costs.
What is a D-SNP?
A Dual Eligible Special Needs Plan is a Medicare Advantage Plan for people with both Medicare and Medicaid that coordinates both sets of benefits.
Can a doctor bill me if I am in the QMB program?
No. Medicare providers are not allowed to bill QMB members for Medicare-covered deductibles, coinsurance or copays.
Talk with a licensed agent
Questions about your Medicare options? Call 1-844-438-6284 (TTY 711) or request a free, no-obligation quote. We do not offer every plan available in your area.
Sources for 2026 figures: CMS 2026 Medicare Parts A & B Premiums and Deductibles; Medicare.gov: Medicare costs; Medicare.gov: Part D costs. For information on all of your options, contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048).