Indiana is home to roughly 240,000 residents who qualify for both Medicare and Medicaid at once, known as dual eligibles. Indiana Medicaid, administered by the Family and Social Services Administration (FSSA), fills the gaps Medicare leaves behind: premiums, deductibles, coinsurance, and long-term services Medicare does not cover at all, like ongoing nursing home care. In 2026, Indiana rolled out a major change for older dual eligibles with the launch of PathWays Dual Care.
Indiana dual eligibility is not one single program. Depending on your age and how much Medicaid you qualify for, you land in Hoosier Care Connect, Indiana PathWays for Aging, or a Medicare Savings Program that only pays your Medicare costs without full Medicaid benefits. This guide walks through Indiana's 2026 income and asset limits by household size, exactly what dual status gets you, and how to apply. For a broader look at qualifying for Medicaid nationally, see Medicaid income limits by state and the 2026 Federal Poverty Level chart.
Direct Answer: Do You Qualify as a Dual Eligible in Indiana?
Yes. You qualify as a Medicare-Medicaid dual eligible in Indiana if you are enrolled in Medicare Parts A and B and your income and assets fall within Indiana Medicaid's limits, about $1,330 a month for one person in 2026. Full duals get Medicaid to cover Medicare's premiums, deductibles, and coinsurance, plus extras like nursing home care. Since January 1, 2026, Indiana's PathWays Dual Care lets duals 60 and older combine both benefits into one integrated plan.
Indiana's Dual Eligible Programs at a Glance
Indiana sorts dual eligibles into three tiers depending on income and age. Full duals, the largest group, qualify for complete Indiana Medicaid benefits on top of Medicare, generally at or below 100% of the federal poverty level ($1,330/month for one person in 2026). Partial duals qualify only for a Medicare Savings Program, which pays Medicare premiums and cost-sharing but no additional Medicaid benefits, at income up to about 135% FPL. Indiana residents age 60 and older who are full duals can now also enroll in PathWays Dual Care, a fully integrated Medicare-Medicaid health plan that launched January 1, 2026.
Indiana residents under 60 who are full duals and not receiving long-term care generally use Hoosier Care Connect, a Medicaid managed care program. Adults 60 and older who need Medicaid, whether living at home, in assisted living, or in a nursing facility, moved into Indiana PathWays for Aging on July 1, 2024, replacing the old Aged and Disabled Waiver and nursing facility fee-for-service system.
What Dual Eligible Status Actually Gets You in Indiana
Indiana dual eligibles get Medicare and Medicaid working together instead of separately. Medicare pays first for doctor visits, hospital stays, and prescription drugs, and Indiana Medicaid pays second, covering costs Medicare leaves behind. In 2026, that means Medicaid pays your $202.90/month Part B premium, your $1,736 Part A hospital deductible, your $283 Part B deductible, and the 20% coinsurance Medicare Part B normally leaves you owing. Full duals also get Medicaid benefits Medicare does not offer at all: long-term nursing facility care, non-emergency medical transportation to appointments, and, depending on the plan, routine dental and vision services.
Every Indiana dual, full or partial, is automatically enrolled in Extra Help (the Part D Low-Income Subsidy), which caps prescription drug copays at a few dollars per prescription and eliminates the Part D deductible. Full duals with PathWays Dual Care also get one care coordinator who manages both their Medicare and Medicaid services so they are not juggling two separate systems and two separate customer service lines.
PathWays Dual Care: Indiana's New Integrated Plan for 2026
Indiana FSSA launched PathWays Dual Care on January 1, 2026, as a voluntary Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) offered through three managed care partners: Anthem, Humana, and UnitedHealthcare. To join, an Indiana resident must be age 60 or older, enrolled in both Medicare Parts A and B, and approved for full Medicaid benefits. Members are not eligible for PathWays Dual Care if they are already in the TBI waiver, ICF/IDD, PACE, or a few other specialized Medicaid programs, since those already coordinate care separately.
Indiana duals under 60, or those with only partial Medicaid, can still enroll in a Coordination-Only D-SNP (CO D-SNP), which coordinates Medicare and Medicaid benefits without merging them into one plan the way PathWays Dual Care does. Either way, Indiana dual eligibles can enroll or switch plans in any month of the year, unlike the once-a-year open enrollment most Medicare beneficiaries face.
Why Duals Don't Use the Healthy Indiana Plan (HIP)
Indiana expanded Medicaid on February 1, 2015, through the Healthy Indiana Plan (HIP) 2.0, covering non-disabled adults ages 19 to 64 with household income up to 138% FPL using MAGI (Modified Adjusted Gross Income) rules. Because Indiana expanded, most low-income working-age adults avoid the ACA coverage gap that still traps residents of the 10 states that never expanded Medicaid. HIP explicitly excludes anyone entitled to Medicare, which is why dual eligibles never enroll in HIP: once you qualify for Medicare, your Medicaid pathway shifts to Hoosier Care Connect, PathWays for Aging, or a Medicare Savings Program instead.
Indiana's income-counting methodology is the key distinction here. HIP uses MAGI, the same tax-based income methodology as the ACA Marketplace, and does not apply an asset test. Full Medicaid pathways for aged, blind, and disabled Hoosiers, including all dual-eligible pathways, instead use non-MAGI, SSI-related income rules, which count income differently and add a resource (asset) test. That is why your household composition and your bank balances both matter for dual-eligible applications in a way they do not for HIP.
How to Apply for Dual Eligible Coverage in Indiana
Indiana residents apply for the Medicaid half of dual eligibility through the FSSA Benefits Portal at fssabenefits.in.gov, the same online system used for all Indiana Medicaid categories. There is no separate dual-eligible application; caseworkers determine your category (full Medicaid, Medicare Savings Program, or neither) based on the income, assets, and household composition you report. Once approved and enrolled in Medicare, PathWays Dual Care enrollment for those 60 and older happens directly with Anthem, Humana, or UnitedHealthcare, or with help from a licensed SHIP counselor at no cost.
Common Reasons Applications Get Denied and How to Appeal
Indiana Medicaid denials for dual-eligible applicants most often come down to income slightly over the limit, unreported assets, or missing documentation. FSSA must send a written denial notice explaining the specific reason and your appeal rights. Indiana residents generally have a limited window stated on the notice, often around 33 days, to request a state fair hearing and keep benefits continuing while the appeal is pending, and longer to request a hearing without continued benefits.
Indiana's free State Health Insurance Assistance Program (SHIP), reachable at 1-800-452-4800, helps with both the Medicaid application and any denial appeal at no charge, and can also explain whether a Medicare Savings Program is a faster path if you do not qualify for full Medicaid outright.
Frequently Asked Questions
What is the income limit to be a dual eligible in Indiana in 2026?
Full Medicaid dual eligibility in Indiana generally requires income at or below 100% of the federal poverty level in 2026, about $1,330 a month for one person or $1,803 a month for a married couple. If your income is higher, up to roughly $1,816 a month for one person, you may still qualify for a Medicare Savings Program that pays Medicare costs without full Medicaid benefits.
What is PathWays Dual Care and who can join?
PathWays Dual Care is Indiana's new Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP), launched January 1, 2026, through Anthem, Humana, and UnitedHealthcare. It combines Medicare and Medicaid benefits into one plan with one care coordinator. To join, you must be age 60 or older, enrolled in Medicare Parts A and B, and approved for full Indiana Medicaid.
What is the difference between QMB, SLMB, and QI in Indiana?
All three are Medicare Savings Programs that pay Medicare costs without granting full Medicaid benefits. QMB (about $1,350/month for one person in 2026) pays Medicare Part A and B premiums plus all Medicare cost-sharing. SLMB (about $1,616/month) and QI (about $1,816/month) pay only the Part B premium. Enrollment in any of the three automatically triggers Extra Help for Part D drug costs.
What documents do I need to apply for dual eligible coverage in Indiana?
You will need your Medicare card, a photo ID, proof of Indiana residency, your Social Security number, proof of income such as a Social Security award letter or pay stubs, and proof of assets like bank statements, since full Indiana Medicaid applies a $2,000 single / $3,000 couple resource test. Apply through fssabenefits.in.gov.
What happens if my Indiana dual-eligible Medicaid application is denied?
FSSA sends a written denial notice with the specific reason and your appeal rights. You generally have around 33 days from the notice to request a state fair hearing and keep receiving benefits during the appeal. Indiana's free SHIP program at 1-800-452-4800 can help you appeal or check whether a Medicare Savings Program is a faster alternative.
Can I work and still be a dual eligible in Indiana?
Yes, within limits. Indiana's full Medicaid dual-eligible pathway uses non-MAGI, SSI-related income rules, which allow certain work-related and impairment-related expense deductions before counting your income against the roughly $1,330/month (2026) limit for one person. If earnings push you over the limit, a Medicare Savings Program at a higher income tier may still apply.
Is Indiana a Medicaid expansion state, and does that affect duals?
Yes. Indiana expanded Medicaid through the Healthy Indiana Plan (HIP) 2.0 on February 1, 2015. Expansion does not directly apply to dual eligibles, since HIP excludes anyone entitled to Medicare. Instead, expansion means Indiana avoids the ACA coverage gap for working-age adults, which indirectly helps residents approaching Medicare age transition smoothly into full Medicaid dual-eligible status.
What's the difference between Hoosier Care Connect and PathWays for Aging?
Hoosier Care Connect serves Indiana Medicaid members who are aged, blind, or disabled but under age 60 and not on Medicare. Indiana PathWays for Aging, which began July 1, 2024, serves Hoosiers 60 and older who need Medicaid, whether at home, in assisted living, or in a nursing facility, and is the pathway most dual eligibles age 60+ now use alongside PathWays Dual Care.
