Yes — you can absolutely have both Medicare and Medicaid at the same time. People who do are called "dual eligible," and it is more common than most folks in Charlotte realize. If you qualify for both, the two programs work together: Medicare pays first, and Medicaid steps in behind it to help with costs Medicare does not cover. For North Carolinians who qualify for full Medicaid on top of Medicare, that can mean little or no out-of-pocket cost for covered care.

Medicare and Medicaid are two different programs

It helps to keep the two straight, because they answer to different rules:

  • Medicare is a federal program. You qualify based on age (65 and older) or disability — not income. Everyone who qualifies gets the same core program, whether they are wealthy or on a tight budget.
  • Medicaid is a joint federal-and-state program run by each state — in our case, North Carolina. Eligibility is based mainly on income and assets, and the rules and limits differ from state to state.

Medicaid also covers some things Medicare generally does not — most notably long-term custodial nursing-home care and personal-care services. Original Medicare covers only up to 100 days of skilled nursing care per benefit period, and only when it is medically necessary; it does not pay for long-term custodial stays. For families in Mecklenburg County facing a nursing-home decision, that difference matters a great deal.

How the two programs work together

When you have both, Medicare pays first (it is your primary coverage) and Medicaid pays second. Medicaid can pick up costs Medicare leaves behind — including Medicare cost-sharing like deductibles, coinsurance, and copays — and can add benefits Medicare does not offer.

There are two levels of dual eligibility:

  • Full dual eligible: You get full Medicaid benefits on top of Medicare, typically with little or no out-of-pocket cost for covered care.
  • Partial dual eligible: You do not get full Medicaid, but you get help through a Medicare Savings Program (more on those below) that pays some of your Medicare costs.

D-SNP plans: Medicare Advantage built for dual eligibles

If you have both Medicare and Medicaid, you may be able to join a D-SNP — a Dual Eligible Special Needs Plan. This is a type of Medicare Advantage plan designed specifically for people who have both programs. Integrated D-SNPs coordinate your Medicare and most or all of your Medicaid benefits through a single plan, which can make care much simpler to manage — one card, one plan, one set of phone numbers instead of two systems that do not talk to each other.

Eligibility for a D-SNP depends on your Medicaid status, and plan availability varies by county. Whether a D-SNP is the right fit is an individual question — no plan type is best for everyone — which is why it is worth comparing your options with someone who represents multiple carriers rather than just one.

Medicare Savings Programs: QMB, SLMB, and QI

Even if you do not qualify for full Medicaid, North Carolina runs Medicare Savings Programs (administered through Medicaid) that help pay Medicare costs for people with limited income:

  • QMB (Qualified Medicare Beneficiary): The most generous. It helps pay your Part A and Part B premiums and your deductibles, coinsurance, and copayments. Providers generally cannot bill a QMB member for those Medicare cost-shares.
  • SLMB (Specified Low-Income Medicare Beneficiary): Helps pay the Part B premium only. The income limits are somewhat higher than QMB.
  • QI (Qualifying Individual): Also helps pay the Part B premium only, for people with income just above the SLMB level. QI is first-come, first-served each year, and you must reapply annually.

For perspective on what that premium help is worth: the standard Part B premium is $202.90 per month in 2026. Having a Medicare Savings Program cover that adds up quickly on a fixed income.

The income and resource limits for these programs are set and administered at the state level, and they change every year — so rather than quote a number that may be outdated, check the current limits with the North Carolina Medicaid office, your local SHIP counselor, Medicare.gov, or 1-800-MEDICARE.

Extra Help with prescription drug costs

Here is a benefit many people miss: enrolling in any of the three Medicare Savings Programs above also automatically qualifies you for Extra Help (also called the Low-Income Subsidy, or LIS) — a federal program that can greatly reduce your Medicare Part D prescription drug costs — the drug plan premium, deductible, and copays. People with full Medicaid or Supplemental Security Income (SSI) are automatically enrolled in Extra Help too; others with limited income can apply through Social Security. The federal income and resource limits change yearly, so check Medicare.gov or ssa.gov for the current figures.

How to find out if you qualify in North Carolina

Because Medicaid and the Medicare Savings Programs are run by the state, qualification comes down to North Carolina's current income and asset limits. A few practical steps:

  • Contact the North Carolina Medicaid office or your local county social services office to ask about Medicaid and Medicare Savings Program eligibility.
  • Call 1-800-MEDICARE or visit Medicare.gov for program details and current-year limits.
  • If you think you are close to the line, apply anyway — the QMB, SLMB, and QI programs each have different limits, and you may qualify for one even if you miss another.

One honest caution: dual eligibility rules, D-SNP availability, and Medicaid status can change from year to year. This is exactly the kind of situation that deserves an annual review, not a one-time decision.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, full-time, licensed insurance agency in Charlotte, North Carolina, serving all of NC. Because we are independent, we represent multiple carriers, so if you have or expect to have both Medicare and Medicaid, we can help you compare the options available in Mecklenburg County and across the state — including the D-SNP (Dual Special Needs) plans we represent — rather than steering you toward one company's option. Our agents complete annual AHIP and carrier certifications, carry errors-and-omissions coverage, and review your coverage every year at renewal, when Medicaid status, plan benefits, and drug formularies can all shift. And the guidance costs you nothing: the carrier pays the agent, and your premium is the same whether you enroll on your own or with our help. If you are sorting out dual eligibility for yourself or a parent, reach out — we will walk through it in plain English.

Plan availability & disclaimer

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 to get information on all of your options. The Jordan Insurance Agency is not connected with or endorsed by the United States government or the federal Medicare program.