Dual Eligible (Medicare + Medicaid) in Kentucky: what changes & what you may qualify for

If you’ve been told you’re “dual eligible” (or you think you might be), it simply means you may qualify for both Medicare and Medicaid at the same time. In Kentucky, this can be a big deal—because it can lower your costs, unlock extra benefits, and even give you more flexibility to change plans during the year.

Below is a clear, Kentucky-specific breakdown of what changes, what you may qualify for, and how to apply.

First: What does “dual eligible” mean?

Medicare is federal health insurance (usually for age 65+ or certain disabilities).
Medicaid is state-run help for people with limited income/resources. Coverage and rules can vary by state.

When you have both, Medicare usually pays first, and Medicaid can help cover remaining costs and may cover services Medicare doesn’t cover (like certain long-term services and supports).

What changes when you have both Medicare + Medicaid?

1) Your out-of-pocket costs can drop (sometimes to $0 for Medicare-covered services)

If you qualify for certain Medicaid help programs (like QMB—explained below), Medicaid can help pay Medicare costs like premiums, deductibles, and coinsurance.

2) You may get billing protections (especially if you’re QMB)

If you’re in the Qualified Medicare Beneficiary (QMB) program, providers aren’t allowed to bill you for Medicare Part A or Part B deductibles, coinsurance, or copays for Medicare-covered services.

3) You may qualify for help with prescription drug costs (“Extra Help”)

“Extra Help” is a Medicare program that helps pay Part D (prescription) costs like premiums and copays. Many people get it automatically if they have full Medicaid or if the state helps pay their Part B premium (like through a Medicare Savings Program).

4) Medicaid may cover benefits Medicare doesn’t (varies by person and program)

Depending on your Medicaid eligibility level, Kentucky Medicaid may help with things like:

• Non-emergency medical transportation (NEMT) to Medicaid-covered services

• Limited adult dental coverage (exams, emergency visits, X-rays, extractions, fillings)

• Home and community-based services through waivers for eligible individuals who need long-term support (like attendant care, respite, home-delivered meals, etc.)

What you may qualify for in Kentucky (the most common categories)

There are two big “levels” of dual eligibility:

A) Full-benefit dual eligible (Full Medicaid + Medicare)

This generally means you get a broader Medicaid benefit package in addition to Medicare (and Medicaid can also help with Medicare cost-sharing). Your specific coverage depends on your Medicaid category and situation.

B) Partial-benefit dual eligible (Medicare + a Medicare Savings Program)

Some people don’t qualify for full Medicaid, but they do qualify for help paying Medicare costs through Kentucky’s Medicare Savings Program (MSP). Kentucky lists these MSP categories and what they pay for.

Kentucky Medicare Savings Programs (MSP): What they pay & 2025 income/resource limits

Kentucky’s CHFS publishes MSP limits and details. Limits change annually, but here are the 2025 monthly income limits shown on the state MSP form/fact sheet:

• QMB (Qualified Medicare Beneficiary)
  Helps pay Part A & Part B premiums, deductibles, and coinsurance
  2025 monthly income limit: $1,325 (individual) / $1,783 (couple)

• SLMB (Specified Low-Income Medicare Beneficiary)
  Helps pay Part B premium only
  2025 monthly income limit: $1,585 (individual) / $2,135 (couple)

• QI-1 (Qualifying Individual)
  Helps pay Part B premium only (limited funding; rules can be stricter)
  2025 monthly income limit: $1,781 (individual) / $2,400 (couple)

• QDWI (Qualified Disabled & Working Individual)
  Helps pay Part A premium for certain working disabled individuals (up to 48 months)

Resource limits (2025): Kentucky’s MSP fact sheet lists resources below $9,660 (one person) or $14,470 (couple).

Do you have to be on Original Medicare, or can you have a plan?

If you’re dual eligible, you can still have different Medicare “setups,” depending on what fits you best:

Option 1: Original Medicare + Medicaid + Part D

You keep Original Medicare as your main coverage, Medicaid helps with costs (depending on eligibility), and you add a drug plan if needed.

Option 2: A Dual Eligible Special Needs Plan (D-SNP)

A D-SNP is a type of Medicare Advantage plan designed for people with Medicare + Medicaid and can help coordinate the two.
(Availability and extra benefits vary by plan and county.)

New in 2025: More flexibility to change coverage monthly (for many dual/LIS members)

CMS created new Special Enrollment Periods starting January 1, 2025 for people who are dually eligible and/or eligible for Extra Help (LIS). In plain English, this can mean more chances to make changes during the year than most Medicare beneficiaries get.

(Exact rules depend on whether you’re full-benefit dual, partial-benefit dual, and what type of plan you’re trying to enroll in.)

How to apply in Kentucky (Medicaid and/or MSP help)

Kentucky CHFS lists these common ways to apply for Medicaid:

• Online using kynect

• By phone through DCBS: (855) 306-8959

• In-person at a DCBS office

For MSP specifically, Kentucky’s MSP materials also point you to kynect/DCBS and the state MSP page.

Important tip: If you’re QMB and you get billed, don’t ignore it

Mistakes happen. But if you’re QMB, federal rules prohibit providers from billing you for Medicare-covered cost-sharing. Show both your Medicare and Medicaid cards and ask the office to re-check your QMB status.

Want help figuring out what you qualify for (and what it changes)?

If you’re in Kentucky and you’re not sure whether you’re full dual vs MSP-only, or whether a D-SNP makes sense, we can walk you through your options and explain it in plain English.

Jackson Insurance Group (JIGKY)
Website: jigky.com
Email: support@jigky.com