Yes, you can have Medicare and Medicaid at the same time. People who do are called "dual eligible." The two programs work together: Medicare pays first, and Medicaid helps with what Medicare leaves behind. This page explains the levels of help, the plans built for people with both, how the rules differ in North Carolina, South Carolina and Tennessee, and how to apply. If you're on Medicare because of a disability, our guide to Medicare under 65 on disability covers the full picture.
What does it mean to be dual eligible?
It means you qualify for Medicare and for help from your state's Medicaid program at the same time. You can be 65 or older, or under 65 and on Medicare because of a disability.
The two programs are different. Medicare is federal health insurance for people 65 and older and for certain people with disabilities. Medicaid is run by each state, with federal funding, for people with limited income and resources, and the rules for who qualifies are different in each state. Qualifying for one doesn't automatically qualify you for the other.
When you have both, Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other insurance you have.
What does Medicaid pay for when you have Medicare?
It depends on which level of help you qualify for. There are two broad levels.
| Level of help | What it can pay for |
|---|---|
| Full Medicaid ("full-benefit dual eligible") | Your Part B premium, and depending on your level, Medicare deductibles, coinsurance and copays, plus services Medicare doesn't cover, such as nursing-home care and personal care services. You also get Extra Help with drug costs automatically. |
| A Medicare Savings Program only ("partial dual") | Your Medicare premiums, and for some programs your Medicare deductibles and coinsurance. You don't get full Medicaid benefits, but you do get Extra Help with drug costs. |
That nursing-home difference is a big one. Medicare covers skilled nursing facility care only for a short time, after a qualifying 3-day inpatient hospital stay, and limits it to 100 days in each benefit period. Medicare doesn't pay for long-term care, also called custodial care. Medicaid can, if you meet your state's rules. See whether Medicare covers long-term care.
How do prescriptions work if I have both?
Your drugs are covered by Medicare, not Medicaid. If you're dual eligible, you're enrolled automatically in a Medicare drug plan if you don't choose one, and Extra Help lowers what you pay. In 2026, people with a Medicare Savings Program pay no more than $12.65 for each covered drug. Medicaid may still cover a drug Medicare doesn't, in certain situations.
What are the Medicare Savings Programs?
They are state programs, run through Medicaid, that pay some or all of your Medicare costs. There are four.
- QMB (Qualified Medicare Beneficiary) pays your Part A premium if you have one, and your Part B premium, deductibles, coinsurance and copays. With QMB, Medicare providers aren't allowed to bill you for Medicare-covered services, including deductibles, coinsurance and copays. Show both your Medicare card and your Medicaid or QMB card every time you get care.
- SLMB (Specified Low-Income Medicare Beneficiary) pays your Part B premium.
- QI (Qualifying Individual) pays your Part B premium. You have to reapply every year, and states approve QI on a first-come, first-served basis.
- QDWI (Qualified Disabled and Working Individual) pays the Part A premium for people with a disability who had to start paying for Part A because they went back to work.
The standard Part B premium is $202.90 a month in 2026, so having it paid adds up to more than $2,400 a year. See how the Part B premium works.
2026 income and resource limits
North Carolina, South Carolina and Tennessee use the same 2026 limits for one person:
| Program | Monthly income limit (one person) and resources |
|---|---|
| QMB | $1,330. Resources up to $9,950 ($14,910 for a couple). |
| SLMB | $1,596. Same resource limit. |
| QI | $1,796. Same resource limit. |
Sources: NC Medicaid, SCDHHS and TennCare. Medicare.gov lists slightly higher amounts ($1,350, $1,616 and $1,816) because states don't count the first $20 of income. Some types of income and resources aren't counted at all, so apply even if you think you're a little over.
Extra Help with drug costs
Extra Help (the Low-Income Subsidy) lowers Part D premiums, deductibles and copays. In 2026, the limits are $23,940 a year in income and $18,090 in resources for one person. You get it automatically if you have full Medicaid, a Medicare Savings Program or SSI. Otherwise, you can apply through Social Security. For more, see help paying for Medicare.
Who qualifies for full Medicaid with Medicare in NC, SC and Tennessee?
The rules for full Medicaid differ more between these three states than anything else on this page.
| State | Main paths to full Medicaid alongside Medicare |
|---|---|
| North Carolina | Full Medicaid for people who are aged, blind or disabled with income up to 100% of the poverty level ($1,330 a month for one person in 2026) and resources up to $2,000. If your income is higher, a "medically needy" program can cover you after you meet a deductible. People who get SSI get Medicaid automatically. |
| South Carolina | Healthy Connections Medicaid covers people who are aged, blind or disabled up to 100% of the poverty level, plus a Working Disabled program. People who get SSI get Medicaid automatically. |
| Tennessee | TennCare's full Medicaid for adults with disabilities comes mainly through SSI and SSI-related groups and long-term care programs (CHOICES). Unlike NC and SC, Tennessee has no full-Medicaid group based only on income for disabled adults who don't get SSI. People who get SSI are enrolled in TennCare automatically. |
In all three states, Medicare Savings Programs are still available to people who don't qualify for full Medicaid. North Carolina's Medicaid expansion is for adults 19 to 64 who don't have Medicare, so it ends once Medicare starts.
What is a D-SNP, and should I consider one?
A D-SNP (Dual Eligible Special Needs Plan) is a type of Medicare Advantage plan only for people who have both Medicare and Medicaid. It can be a good fit for some people and not others.
D-SNPs include Medicare drug coverage and help coordinate your Medicare and Medicaid benefits. Whether you can join depends on your Medicaid level and the plan. Full and partial duals can qualify, depending on the state and plan. You can also keep Original Medicare with a drug plan and let Medicaid work behind it. Neither choice is automatically right. It depends on your doctors, your prescriptions and the services you use.
Integrated D-SNPs: one plan for both programs
Some D-SNPs go further and manage your Medicare and Medicaid benefits through the same company. These "integrated" plans are where the three states differ most:
- North Carolina: CMS's 2026 list shows no integrated D-SNPs.
- South Carolina: CMS's 2026 list shows four integrated D-SNPs.
- Tennessee: CMS's 2026 list shows six, all fully integrated with TennCare, meaning one plan, one card and one member handbook for both programs. TennCare says that by January 2027, people with full TennCare who want a D-SNP must get their Medicare and TennCare benefits from the same plan.
When can I change plans if I have both?
More often than most people with Medicare. Since January 1, 2025, two monthly windows apply.
- The monthly dual and Extra Help window. If you have Medicaid or Extra Help, you can make a change once a month to move to Original Medicare with a stand-alone drug plan, or to switch drug plans. You can't use it to join a regular Medicare Advantage plan.
- The integrated care window. If you have full Medicaid, you can join an integrated D-SNP that lines up with your Medicaid plan once a month, where those plans exist.
You also have the usual windows everyone with Medicare has, including Open Enrollment from October 15 to December 7. See Medicare Special Enrollment Periods.
How do I apply in NC, SC or Tennessee?
You apply through your state Medicaid agency. The same application covers full Medicaid and the Medicare Savings Programs, and the state decides which you qualify for.
| State | How to apply |
|---|---|
| North Carolina | NC Medicaid: online, in person, by phone, or by mail through your county Department of Social Services. The NC Medicaid Contact Center is 1-888-245-0179. A decision can take up to 45 days, or up to 90 days for a disability-based application. |
| South Carolina | Healthy Connections Medicaid: apply online through SCDHHS, or call (888) 549-0820. SC Thrive offers help with the application. |
| Tennessee | TennCare: apply online through TennCare Connect, by phone at 855-259-0701, or with a paper application, for TennCare Medicaid and the Medicare Savings Programs. |
Have your Medicare card, Social Security award letter, bank statements and proof of income ready.
If you're on Medicare because of a disability
Medicaid can be especially valuable under 65, because Medicare Supplement options are limited in some states. In North Carolina, Medicaid expansion can cover people while they wait for Medicare, but it ends once Medicare starts. That's the moment to check whether you qualify for full Medicaid or a Medicare Savings Program instead. The new Medicaid work requirements starting in 2027 don't apply to people with Medicare. If you're weighing plans, see Medicare Advantage under 65 on disability and what to do when your Medicare card arrives.
Mistakes we see people make
- Not applying because they think they earn too much. State rules don't count every type of income or resource, and the Medicare Savings Program limits go higher than full Medicaid's.
- Paying a bill they shouldn't. With QMB, providers can't bill you for Medicare cost-sharing. Show both cards every time.
- Letting QI lapse. It has to be renewed every year.
- Joining a plan without checking that doctors and pharmacies work with it, especially when switching to a D-SNP.
- Missing a Medicaid renewal letter, which can end help with Medicare costs.
What to have ready before you talk to us
- Your Medicare card and any Medicaid or QMB card
- Any letters from your state Medicaid agency or Social Security
- Your monthly income and a rough total of savings and other resources
- Every doctor, specialist and pharmacy you use, and every prescription with the dose
- Anyone who helps manage your care, so they can join the call
How The Jordan Insurance Agency helps
A licensed agent from The Jordan Insurance Agency will help you understand which level of help you may qualify for, point you to the right state application, and compare Original Medicare with a drug plan against the D-SNPs available where you live, checking your doctors and prescriptions first. We work by phone, by video, or in person at our office at 3540 Toringdon Way, Suite 200, Charlotte, NC 28277, Monday through Friday, 9 to 5 Eastern, at no cost to you. Call (704) 926-7565 or use the button below to schedule a Medicare review. You can also read more on our Medicare page or browse our Medicare questions answered.
Frequently asked questions
Does Medicaid pay my Medicare Part B premium?
Yes, if you have full Medicaid or a Medicare Savings Program (QMB, SLMB or QI). The state pays the Part B premium, the 2026 standard amount is $202.90 a month, so it no longer comes out of your Social Security check.
Can a doctor bill me if I have QMB?
No, not for Medicare-covered services. Medicare providers aren't allowed to bill people in the QMB program for Medicare deductibles, coinsurance or copays. You may owe a small Medicaid copay. Show both your Medicare and Medicaid or QMB cards.
Do I get my prescriptions from Medicare or Medicaid if I have both?
From Medicare. People with both are enrolled in a Medicare drug plan, and Extra Help lowers the cost. In 2026, people with a Medicare Savings Program pay no more than $12.65 for each covered drug.
How often can I change my plan if I have Medicare and Medicaid?
Once a month, you can move to Original Medicare with a drug plan or switch drug plans. If you have full Medicaid, you can also join an integrated D-SNP that matches your Medicaid plan once a month, where those plans are offered.
Are there integrated D-SNPs in North Carolina?
Not on CMS's 2026 list. That list shows none in North Carolina, four in South Carolina and six in Tennessee. Regular D-SNPs may still be offered in your county.
Reviewed and approved by Billy Jordan, Jr., licensed agent and President of The Jordan Insurance Agency.
Last reviewed: October 2026
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