Florida Medicaid and Medicare: How They Work Together If You Qualify for Both
Yes, you can have Florida Medicaid and Medicare at the same time. In June 2026, 916,719 Floridians did, about 17.2% of the state's 5,334,437 Medicare beneficiaries, according to CMS enrollment data. People with both are called "dual eligible," and the two programs don't compete: Medicare pays first, and Medicaid pays last.
What Medicaid actually pays depends on which kind of dual you are, and Florida's rules have a quirk worth knowing. Its main Medicaid group for low-income seniors, MEDS-AD, covers someone on Medicare only if that person is also getting nursing home, hospice or home and community-based long-term care. So for a Floridian living at home on Social Security, full Medicaid usually comes through SSI or through the Medically Needy "share of cost" program, and the more common help is a Medicare Savings Program that pays premiums and cost sharing.
Below: the full versus partial dual split, what Medicaid pays once Medicare has paid, Florida's 2026 income and asset lines, how share of cost is calculated (with the math), long-term care, drug coverage, the enrollment rules that apply only to duals, and where to apply.
Source: CMS Medicare Monthly Enrollment, Florida, June 2026; DCF Appendix A-9, July 2026.
Full duals and partial duals
CMS sorts everyone with both programs into categories (its Dual Eligibility Categories document). People who get the full Medicaid benefit package on top of Medicare are "full-benefit" duals. People whose Medicaid only pays Medicare premiums, and sometimes Medicare cost sharing, are "partial-benefit" duals. That second group is entirely Medicare Savings Programs.
| CMS category | What Medicaid pays | Florida, June 2026 |
|---|---|---|
| QMB Only (partial) | Part A premium (if any), Part B premium; providers can't bill you Medicare deductibles, coinsurance or copays | 307,569 |
| QMB Plus (full) | Everything QMB pays, plus full Medicaid benefits | 342,152 |
| SLMB Only (partial) | Part B premium only | 116,651 |
| SLMB Plus (full) | Part B premium plus full Medicaid benefits | 18,365 |
| QI and QDWI (partial) | QI: Part B premium, if the state has funded slots (federal annual allotment). QDWI: Part A premium for certain working people with disabilities | 66,231 |
| Other full-benefit dual | Full Medicaid, but not QMB or SLMB; Medicare cost sharing on Medicare-only services is owed unless the state covers it | 65,751 |
Source: CMS Medicare-Medicaid Coordination Office, Dual Eligibility Categories (revised Jan. 15, 2025); CMS Medicare Monthly Enrollment, Florida, June 2026.
QMB is the category that matters most day to day. Under federal rules, Medicare providers may not bill a QMB for Medicare Part A and Part B deductibles, coinsurance or copays. You may get a bill for a small Medicaid copayment, but not for the Medicare cost sharing. Medicare.gov tells QMB enrollees to show both the Medicare card and the Medicaid (or QMB) card every time they get care. If a doctor's office in Tampa sends you a bill for a Part B coinsurance anyway, that's the card to point to.
Florida's income lines for the Medicare Savings Programs, the asset test and when coverage starts are in our separate guide: Medicare Savings Program in Florida. I won't repeat those tables here.
Who pays first, and what Medicaid adds
Medicare.gov puts the order plainly: "Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have." CMS's categories document says the same thing in regulatory language: Medicare pays primary to Medicaid for Medicare-covered services.
So for a hospital stay, a doctor visit or lab work, Medicare processes the claim first. What's left over, the deductible and coinsurance, is where Medicaid comes in, depending on your category. For 2026 the amounts at stake are the Part B premium of $202.90 a month, the Part B deductible of $283, and the Part A hospital deductible of $1,736 per benefit period (CMS 2026 fact sheet).
Full Medicaid also covers things Medicare doesn't normally cover. Medicare.gov names nursing home care and personal care services as examples. That's the real reason full dual status matters for older Floridians: Medicare is built for medical care, not for help bathing and dressing or for a long nursing home stay.
| Cost | Who pays it for a dual |
|---|---|
| Medicare-covered services | Medicare pays first |
| Part B premium | Medicaid, for QMB, SLMB, QI and full-benefit duals |
| Part A premium (only if you don't get it premium-free) | Medicaid for QMB; for QDWI, the Part A premium only |
| Medicare deductibles and coinsurance | Medicaid for QMB (and providers can't bill you); for other groups, depends on the category and the service |
| Prescription drugs | A Medicare drug plan, with Extra Help, not Medicaid |
| Nursing home care and personal care | Medicaid, for people who qualify for full Medicaid and its long-term care rules |
Source: Medicare.gov, Medicaid; CMS Dual Eligibility Categories.
One change in the news doesn't touch this group. Medicare.gov notes that the Medicaid work requirement starting January 1, 2027 "doesn't apply to people with Medicare."
Florida's routes into Medicaid when you have Medicare
Florida's Department of Children and Families (DCF) decides financial eligibility. Its July 2026 standards table (Appendix A-9) and policy manual set out the groups. Here are the ones that matter for someone on Medicare, by monthly income for one person.
Source: DCF Appendix A-9, July 2026; MSP lines from DCF Appendix A-9.1, April 2026
Show the numbers
| Program | Monthly limit |
|---|---|
| Medically Needy income level | $180 |
| SSI federal benefit rate | $994 |
| MEDS-AD (88% of poverty) | $1,171 |
| QMB (100%) | $1,330 |
| SLMB (120%) | $1,596 |
| QI-1 (135%) | $1,796 |
| Nursing home / HCBS cap (300% of SSI) | $2,982 |
| Route | Income, 1 person | Assets, 1 person | Catch for Medicare enrollees |
|---|---|---|---|
| SSI | SSI rules ($994 federal benefit rate) | SSI rules | If you get SSI, Florida Medicaid follows automatically |
| MEDS-AD | $1,171 | $5,000 | Only if you're also getting institutional, hospice or home and community-based care |
| Medically Needy | No limit; share of cost above $180 | $5,000 | Covered only after the month's medical bills reach your share of cost |
| Institutional care (ICP), hospice, HCBS | $2,982 | $2,000 | Need nursing home level of care (ICP/HCBS) or a hospice election; income trust possible above the cap |
| Medicare Savings Programs | Up to $1,796 (QI-1) | $9,950 | Pays premiums and, for QMB, cost sharing; not full Medicaid |
Source: DCF Appendix A-9, July 2026; DCF Appendix A-9.1, April 2026 (Medicare Savings Programs); DCF ESS Program Policy Manual, chapter 2000 (passages 2040.0801.03, 2040.0813.01 to .05, 2040.0815.01); chapter 2400 (2440.0102, 2440.0103).
The MEDS-AD catch. MEDS-AD is the group for aged and disabled Floridians with income at or below 88% of the poverty level, $1,171 a month for one person, $1,588 for a couple, with assets at or under $5,000 ($6,000 for a couple). But DCF's manual (passage 2040.0813.03) lists a technical requirement: the person must "not be receiving Medicare, or if receiving Medicare also be receiving institutional, hospice or home and community based services." A retiree in Port St. Lucie living at home with Medicare and $1,100 a month doesn't get full Medicaid through MEDS-AD. After the $20 disregard she's under the QMB line, so if her assets pass she could get QMB, and DCF could also look at Medically Needy.
SSI. If Social Security pays you SSI, DCF's manual says Medicaid "always results from SSI entitlement." No separate Florida income test.
Medically Needy. This is Florida's spend-down. There's no income limit to enroll, but you're only covered for a month once your medical bills for that month reach your share of cost. The manual also says people who fit MEDS-AD except for too much income have to be considered under Medically Needy (passage 2040.0803). More on the math below.
Medically Needy: how share of cost works
DCF's own FAQ says "your share of cost works like a deductible on a health insurance policy." The formula is in passage 2640.0500 of the manual: take your countable net income, subtract the Medically Needy Income Level (MNIL) for your household size, and the difference is your monthly share of cost. The July 2026 MNIL is $180 for one person and $241 for a couple, with an asset limit of $5,000 for one person and $6,000 for a couple.
A few rules decide whether you ever meet it:
- It resets every month. You're eligible from the day your bills reach the share of cost through the end of that month (passage 2640.0502).
- Premiums count. Medical and other health insurance premiums, deductibles and coinsurance are allowable expenses (2640.0506.03). A Medicare premium is dated the first day of the month (2640.0505), and DCF can accept your statement as proof of it (2640.0508).
- Old bills can count. Unpaid bills you still owe, bills paid this month, and bills paid in the three months before the tracking month (no earlier than the three retroactive application months) are allowable (2640.0506.01). Anything Medicare or another insurer pays doesn't count.
- You call DCF. Once you meet it, you contact DCF to complete bill tracking, and DCF approves Medicaid for the rest of the month. Medically Needy enrollees don't get a Medicaid card, according to the DCF FAQ.
Source: DCF ESS Program Policy Manual, chapter 2600 (2640.0500 to 2640.0508); chapter 2400 (2440.0322, $20 standard disregard); DCF Appendix A-9, July 2026; CMS 2026 Part A and B amounts. Illustration only; DCF calculates your actual share of cost.
Source: DCF manual chapter 2600; CMS 2026 fact sheet; author's calculation
Show the numbers
| Dollars | |
|---|---|
| Share of cost | $1,700 |
| Quiet month | $203 |
| Hospital month | $1,939 |
My read: Medically Needy works for people with big, lumpy medical costs, like a hospital stay or ongoing home care. For someone whose costs are steady and modest, the share of cost is often too high to meet. Ask DCF to run it anyway; the table is a screen, not a decision.
Nursing homes and long-term care
This is where Medicare runs out. Medicare covers skilled nursing facility care only after a qualifying inpatient hospital stay of at least three days, and only up to 100 days per benefit period: days 1 to 20 with no daily coinsurance after the Part A deductible, days 21 to 100 at $217 a day in 2026, and from day 101 you pay all costs. Custodial care for someone who just can't live alone anymore isn't what that benefit is for.
For QMB enrollees, DCF's manual says Medicaid pays the full Medicare coinsurance for nursing home care during the Medicare benefit period. Past that, Florida Medicaid long-term care runs through two doors:
- Institutional Care Program (ICP) for nursing home residents, with the income cap of $2,982 a month (300% of the SSI rate) and an asset limit of $2,000 for one person. If income is over the cap, passage 2440.0103 allows a qualified income trust.
- The Statewide Medicaid Managed Care Long-Term Care program (SMMC LTC), run by the Agency for Health Care Administration (AHCA), for people 65 and older (or 18 and older with a disability) who are Medicaid eligible and whom the Department of Elder Affairs' CARES unit finds need nursing home level of care. It covers services such as assisted living, home-delivered meals, personal care, adult day health care and nursing facility care. AHCA's FAQ says it's "not an entitlement program like Medicaid state plan," and it doesn't include doctor visits or hospital stays (Medicare and regular Medicaid cover those).
Home and community-based slots are limited. The process is a screening by phone with your local Aging and Disability Resource Center, a place on a waitlist ranked by priority score, then a CARES assessment and DCF's financial decision. And you can't get home and community-based services through Medically Needy (manual passage 2040.0815.01).
| Florida standard (July 2026) | Amount |
|---|---|
| Nursing home / HCBS income cap, one person | $2,982/mo |
| Asset limit, one person (couple) | $2,000 ($3,000) |
| Personal needs allowance, nursing home | $160/mo |
| Minimum monthly maintenance needs allowance (spouse at home) | $2,705/mo |
| Community spouse resource allowance (CSRA) | $162,660 |
| Home equity interest limit | $752,000 |
Source: DCF Appendix A-9, SSI-Related Medicaid Coverage Groups Financial Eligibility Standards, July 2026; AHCA, Who can receive LTC services.
The spousal figures protect the husband or wife who stays at home, and how they apply to a couple's actual accounts and house is legal territory. If one spouse is heading into a nursing home, talk to an elder law attorney before moving money around.
Drug coverage: Extra Help comes automatically
Duals get prescriptions through Medicare Part D, not Medicaid. Medicare.gov says you'll be enrolled in a Medicare drug plan automatically if you don't pick one. You also get Extra Help (the Part D Low-Income Subsidy) automatically if you have full-benefit Medicaid, a Medicare Savings Program, or SSI (Medicare.gov, Extra Help).
For 2027, Medicare.gov lists Extra Help copays of up to $5.80 for each generic and up to $14.40 for each brand-name drug, and no cost for covered drugs once total drug costs reach $2,400. People with full Medicaid who are also in QMB pay no more than $4.90 per covered drug. Extra Help stays in place through December 31 even if income changes mid-year. Our Part D 2027 guide covers the rest of next year's drug rules, and our Florida Part D page explains how drug coverage works in Florida.
Changing your Medicare coverage as a dual
Most people with Medicare can change drug coverage only at set times, like Open Enrollment (October 15 to December 7, which is under way now). Duals have more room, under 42 CFR 423.38:
| Situation | What you can do | When |
|---|---|---|
| You have Medicaid or Extra Help | Switch to a different Medicare drug plan, or leave a Medicare Advantage plan with drug coverage and go back to Original Medicare by joining a stand-alone drug plan | Once a calendar month; change starts the 1st of the next month |
| You have full Medicaid | Join or switch to an integrated dual eligible special needs plan (D-SNP), if one is available where you live | Once a calendar month; starts the 1st of the next month |
| You gain, lose or change Medicaid or Extra Help | Make a Medicare Advantage or drug plan change | Within 3 months of the change or the notice, whichever is later |
Source: 42 CFR 423.38(c)(4), (c)(9) and (c)(35) (eCFR, current as of Oct. 2026); Medicare.gov, Special Enrollment Periods.
Two caveats. The monthly drug-plan change isn't available to anyone a Part D drug management program has flagged as an "at-risk" or "potential at-risk" beneficiary; you'd get a letter saying so. And not every D-SNP is integrated with Medicaid. Medicare.gov suggests calling 1-800-MEDICARE for a list of integrated ones. The full list of other enrollment periods is in our Medicare Special Enrollment Period guide.
How many Floridians are dual eligible
- Full-benefit duals
- Partial-benefit duals
Source: CMS Medicare Monthly Enrollment, Florida, state level
Show the numbers
| Full-benefit duals | Partial-benefit duals | |
|---|---|---|
| 2019 | 399K | 444K |
| 2020 | 418K | 461K |
| 2021 | 460K | 468K |
| 2022 | 497K | 469K |
| 2023 | 516K | 473K |
| 2024 | 458K | 480K |
| 2025 | 432K | 468K |
| Jun 2026 | 426K | 490K |
Full-benefit duals peaked at 516,007 in CMS's 2023 annual figure and were 426,268 by June 2026. Partial duals, the Medicare Savings Program group, have stayed in a narrow band, between about 443,000 and 490,000. Florida's Medicare enrollment grew faster, from 4,556,578 in 2019 to 5,334,437 in June 2026, so the dual share is now a little over one in six.
If your countable income is under the QMB line of $1,330 a month and nobody is paying your Part B premium for you, check whether you qualify. That premium alone is $2,434.80 a year in 2026.
How to apply in Florida
- Medicaid and Medicare Savings Programs: apply with DCF online at MyACCESS, which DCF calls the quickest way, or through a DCF community partner, a customer service center, or a paper application. The DCF Customer Call Center is 1-850-300-4323. DCF says processing can take up to 30 days, longer if a disability decision is needed.
- Long-term care: call your local Aging and Disability Resource Center or the Elder Helpline at 1-800-96-ELDER (1-800-963-5337) for the SMMC LTC screening.
- Problems with Medicaid long-term care services: AHCA's Medicaid helpline is 1-877-254-1055.
- Unbiased Medicare counseling: SHINE, run by the Florida Department of Elder Affairs, at 1-800-963-5337, or 1-800-MEDICARE.
If you're close to any line in this article, apply and let DCF decide. Income and asset rules have deductions and exclusions that a table can't show. For general Medicare questions in Florida, see our Florida Medicare page or send us a message.
FAQ
Can you have Medicare and Medicaid at the same time in Florida?
Yes. People with both are called dual eligible; CMS counted 916,719 in Florida in June 2026. Medicare pays first and Medicaid pays last.
What does Florida Medicaid pay if I have Medicare?
It depends on your category. A Medicare Savings Program pays the Part B premium, and QMB also covers Medicare deductibles and coinsurance. Full Medicaid adds services Medicare doesn't normally cover, like nursing home care and personal care.
How is share of cost calculated in Florida?
DCF subtracts the Medically Needy Income Level ($180 a month for one person in July 2026) from your countable income. The difference is the medical bills you must incur each month before Medicaid covers the rest of that month.
Can I get MEDS-AD if I'm on Medicare?
Only if you're also receiving institutional, hospice or home and community-based care, according to DCF's policy manual. Otherwise, look at SSI, Medically Needy and the Medicare Savings Programs.
Your own coverage documents and current state and federal rules control what you get. Confirm your situation with DCF, SHINE or a licensed agent, and for legal questions such as trusts or spousal planning, an elder law attorney.
Sources
- CMS Medicare-Medicaid Coordination Office: Dual Eligibility Categories (revised Jan. 15, 2025)
- CMS Medicare Monthly Enrollment, Florida (data through June 2026)
- Medicare.gov: Medicaid
- Medicare.gov: Medicare Savings Programs
- Medicare.gov: Help with drug costs (Extra Help)
- Medicare.gov: Special Enrollment Periods
- Medicare.gov: Skilled nursing facility care
- CMS: 2026 Medicare Parts A and B premiums and deductibles
- eCFR: 42 CFR 423.38, enrollment periods
- Florida DCF Appendix A-9: SSI-Related Medicaid Coverage Groups Financial Eligibility Standards, July 2026
- Florida DCF Appendix A-9.1: Medicare Savings Programs and LIS Financial Standards, April 2026
- Florida DCF ESS Program Policy Manual, chapter 2000: Coverage Groups
- Florida DCF ESS Program Policy Manual, chapter 2400: Budgeting Income
- Florida DCF ESS Program Policy Manual, chapter 2600: Calculation of Benefits
- Florida DCF: Economic Self-Sufficiency FAQ
- Florida AHCA: Who can receive Long-Term Care services
- Florida AHCA: SMMC Long-Term Care recipient FAQs
- SHINE, Florida Department of Elder Affairs
This article is for general educational purposes only and is not legal, tax or insurance advice. Coverage depends on the actual policy, its terms, conditions and exclusions, and state law. Maru Insurance · WA License (WAOIC) #1365574 · FL License #G363233 · NPN 22261820.