If you qualify for both Medicare and Medicaid, you’ve probably wondered the practical question behind all the paperwork: when the bills come, how much is actually yours to pay? For many people, the honest answer is “very little — often close to nothing.”
What being “dual eligible” means for your wallet
Dual eligible simply means you qualify for both Medicare and Medicaid. That second program is what changes the math. Medicaid, and the related Medicare Savings Programs (MSPs), step in to cover the costs Medicare normally leaves on your shoulders.
How much help you get depends on which category you fall into. Let’s walk through the costs one at a time.
The Part B premium
Almost everyone on Medicare pays a monthly Part B premium — the standard amount is $202.90 a month in 2026. For dual eligible members, this is usually covered for you.
- Full duals (full Medicaid plus Medicare): the premium is paid on your behalf.
- QMB (Qualified Medicare Beneficiary): pays your Part B premium, and your Part A premium if you owe one.
- SLMB and QI: these pay the Part B premium only.
When the premium is covered, you often see it as a bigger Social Security check, because the $202.90 is no longer deducted each month.
Deductibles, coinsurance, and copays
This is where the categories really differ — and where the savings get largest.
Full duals and QMB members get the most protection. The program covers:
- The Part B deductible ($283 in 2026)
- The Part A hospital deductible ($1,736 per benefit period)
- The 20% coinsurance and copays you’d otherwise owe under Original Medicare
That last point matters a lot, because Original Medicare alone has no out-of-pocket maximum. A long hospital stay or a run of specialist visits could otherwise pile up with no ceiling. For QMB members there’s an extra safeguard: providers may not balance-bill you for Medicare cost-sharing. If you’re billed anyway, you can show your QMB notice. You can read more in our guide to the QMB program.
SLMB and QI are narrower. They pay your Part B premium, but they don’t cover your deductibles, coinsurance, or copays. You’d still owe those out of pocket.
| Program | Part B premium | Deductibles & copays |
|---|---|---|
| Full dual | Covered | Covered |
| QMB | Covered | Covered |
| SLMB | Covered | Not covered |
| QI | Covered | Not covered |
Prescription drug costs
Dual eligible members get help here too. Full duals automatically qualify for Extra Help (also called the Low-Income Subsidy) for Part D. With Extra Help, your drug costs drop sharply: you pay no more than $12.65 per covered drug in 2026, plus a reduced or $0 plan premium and deductible.
So instead of a deductible and a long stretch of cost-sharing, your prescriptions usually come down to a small, predictable copay at the pharmacy.
A quick word on IRMAA
You may have heard about IRMAA, an income surcharge that raises the Part B and Part D premiums for higher earners. For dual eligible members, this almost never comes up. IRMAA only kicks in above $109,000 for a single person (based on income from two years prior), and duals have limited income well below that line. In short, if you’re a dual, IRMAA generally doesn’t apply to you.
If your income is higher and you’re not a dual, it’s a different story — our IRMAA Calculator can show you what those surcharges would look like.
So what do you actually pay?
For full duals and QMB members, the realistic answer is that your out-of-pocket Medicare cost is often near $0 — premiums covered, deductibles covered, copays covered, and drugs down to a few dollars each. For SLMB and QI, you save the Part B premium but still handle your own cost-sharing.
These are 2026 figures, and they update periodically. Utah Medicaid makes the final call on which program you qualify for, so it’s always worth checking the current numbers and applying through the state. To see how your specific costs might shake out, try the Medicare Cost Estimator.
If you’re not sure where you land — or you think you should be getting more help than you are — I’m happy to look at it with you. You can reach out anytime for a calm, no-pressure conversation about your situation.