Full answer: Yes. A Maryland resident enrolled in both Medicare and Medicaid, known as a dual eligible, keeps Original Medicare as primary coverage for hospital and medical care while Maryland Medical Assistance covers the gaps: Medicare premiums, deductibles, coinsurance, long-term care, and non-emergency medical transportation that Medicare does not pay for. Maryland offers two paths: full Medical Assistance for people who meet the state's aged, blind, and disabled income and asset limits, and the Medicare Savings Programs (QMB, SLMB, and QI) for people with slightly higher income who need help only with Medicare premiums and cost-sharing. In 2026, Maryland's QMB income limit is $1,350 per month for an individual and $1,824 for a couple, with no asset test.
Maryland Medical Assistance and Medicare do not compete for residents who qualify for both; they combine into a coverage status called dual eligibility. Understanding what dual eligible status actually pays for in 2026, from the Medicare Part B premium to long-term nursing home care, matters because the rules differ sharply depending on whether a Marylander qualifies for full Medical Assistance or only a Medicare Savings Program tier such as QMB, SLMB, or QI. This guide breaks down Maryland's 2026 income limits by household size, what dual eligibles actually get beyond Original Medicare, and the exact steps to apply through Maryland's Department of Human Services.
Nationally, dual eligibles number about 12 million people, and Maryland's Medicare population includes a meaningful share of seniors and people with disabilities who rely on Maryland Medical Assistance to afford Medicare cost-sharing. For the broader household-eligibility picture, see Maryland Medicaid income limits and Medicaid vs. Medicare Savings Program. Check eligibility for either program using the screener tool linked on this page.
Quick Answer: Dual Eligible Coverage in Maryland
Yes. Maryland residents who have both Medicare and Medicaid, called dual eligibles, get Medicare Part A and Part B coverage first, then Maryland Medical Assistance pays the Medicare Part B premium, deductibles, and coinsurance for many enrollees, plus benefits Medicare does not cover, such as long-term care and non-emergency transportation. Eligibility depends on income and, for some pathways, assets. In 2026, a single person generally qualifies for the Qualified Medicare Beneficiary program at $1,350 per month or less.
What Dual Eligible Means in Maryland
Maryland residents who qualify for both Medicare and Maryland Medical Assistance are called dual eligibles, and the state currently has two distinct paths into that status. Full dual eligibility applies to people who meet Maryland's income and asset limits for Aged, Blind, and Disabled Medical Assistance, which uses a non-MAGI (Modified Adjusted Gross Income) methodology tied to being 65 or older or having a disability determination, separate from the MAGI-based Medicaid expansion pathway that covers most adults under 65. Partial dual eligibility, sometimes called Medicare Savings Program-only status, applies to people whose income is too high for full Medical Assistance but who still qualify for help with Medicare costs through the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Individual (QI) programs.
Nationally, about 12 million Americans are dual eligible, concentrated among seniors and people with disabilities who have limited retirement savings. Full duals get the broadest benefit package: Medicare stays primary for hospital and medical care, and Maryland Medical Assistance wraps around it with long-term care, behavioral health, and cost-sharing help. Partial duals in the QMB, SLMB, or QI tiers get help only with specific Medicare costs; SLMB and QI cover the Part B premium alone, while QMB additionally covers deductibles, coinsurance, and copays. A fourth, narrower Medicare Savings Program tier, Qualifying Disabled and Working Individuals (QDWI), helps working people under 65 with disabilities pay the Part A premium but does not add Medicaid health coverage.
Maryland Medical Assistance and Medicare Savings Program Income Limits by Family Size (2026)
Maryland scales its Medical Assistance and Medicare Savings Program income limits by family size, using the same federal poverty guidelines the U.S. Department of Health and Human Services publishes each January. The table below shows the 2026 income ceiling for the Qualified Medicare Beneficiary (QMB) tier, set at 100% of the federal poverty level (FPL), which is also the benchmark most partial duals must clear first. Maryland then layers two higher tiers on top of QMB: SLMB at 120% FPL and QI at 135% FPL, both covering only the Medicare Part B premium. Maryland has eliminated the asset test for QMB, SLMB, and QI, so a home, a car, or modest savings no longer disqualify an applicant on those three tiers.
Maryland Medicare Savings Program income limits by tier, 2026| Program | Individual monthly limit (2026) | Couple monthly limit (2026) | What it pays |
|---|
| Qualified Medicare Beneficiary (QMB) | $1,350 | $1,824 | Part B premium, Part A premium if owed, deductibles, coinsurance, and copays |
| Specified Low-Income Medicare Beneficiary (SLMB) | $1,616 | $2,184 | Part B premium only |
| Qualified Individual (QI) | $1,816 | $2,455 | Part B premium only; limited annual funding, first-come first-served |
| Full Medical Assistance (Aged, Blind, and Disabled, medically needy) | $350 monthly standard; spend-down allowed above that | $392 for a household of two; spend-down allowed | Full Medicaid benefits plus Medicare wraparound, including long-term care |
QMB, SLMB, and QI limits equal 100%, 120%, and 135% of the 2026 federal poverty level plus Maryland's $20 general income disregard. Maryland has no asset test for these three Medicare Savings Program tiers; the medically needy standard applies only to full Medical Assistance long-term care cases.
Source: Maryland Department of Health, Medicare Savings Programs; CMS Medicare Savings Programs; ASPE 2026 Poverty Guidelines
What Maryland Dual Eligibles Actually Get
Maryland dual eligibles keep Medicare as their primary coverage, so Medicare Part A pays for hospital stays, Medicare Part B pays for doctor visits and outpatient care, and Medicare Part D pays for prescription drugs, each governed by the same 2026 Medicare rules that apply nationwide. Maryland Medical Assistance then fills the gaps Medicare leaves open. Beneficiaries in the QMB tier owe $0 toward the standard $202.90 monthly Part B premium in 2026 because Medicaid pays it directly, and QMB also picks up the 2026 Part B deductible of $283 and the 20% Part B coinsurance that Original Medicare enrollees normally pay out of pocket. Full Medical Assistance duals additionally get benefits Medicare does not cover at all, including long-term nursing facility care, home and community-based waiver services, non-emergency medical transportation, and, since 2023, adult dental coverage.
Full-benefit dual eligibles in Maryland are automatically enrolled in the Extra Help program (also called the Part D Low-Income Subsidy), which caps 2026 Medicare Part D out-of-pocket drug costs far below the standard $2,100 catastrophic threshold and typically reduces copays to a few dollars per prescription. Maryland dual eligibles can also enroll in a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan built specifically to coordinate Medicare and Medicaid benefits, often with a $0 premium, extra dental and vision allowances, and a care coordinator. CMS allows many dual eligibles a monthly Special Enrollment Period to switch D-SNPs, in addition to the standard Medicare Advantage Open Enrollment Period from January 1 to March 31, 2026.
How to Apply for Maryland Medical Assistance and Medicare Savings Programs
Maryland residents apply for Medical Assistance and Medicare Savings Programs through the state's Department of Human Services rather than the ACA marketplace, since most dual-eligible applicants qualify based on age or disability rather than household income under MAGI rules. The fastest route is Maryland's online myDHRbenefits portal, though applicants can also apply by phone or in person at a Local Department of Social Services office. Because Medicare Savings Program eligibility in Maryland requires active Medicare Part A and Part B enrollment first, applicants who are not yet enrolled in Medicare should contact Social Security before starting the Medical Assistance application to avoid a processing delay.
- Confirm Medicare Part A and Part B enrollment before applying.
- Gather income, identity, and residency documents.
- Apply online via myDHRbenefits, by phone, or at a Local Department of Social Services office.
- Submit the application and respond quickly to any verification request.
- Wait for a determination, typically 45 to 90 days.
- Enroll in a Dual Eligible Special Needs Plan (D-SNP) once approved, if desired.
Is Maryland a Medicaid Expansion State?
Maryland expanded Medicaid under the Affordable Care Act on January 1, 2014, making it one of the earliest expansion states and one of more than 40 states plus Washington, D.C. that now cover adults up to 138% FPL (138% of the federal poverty level) using MAGI rules. Expansion matters most for Marylanders under 65 without a disability determination, since it closed the ACA gap that still traps low-income adults in the 10 states that have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Most dual eligibles, however, qualify through the separate non-MAGI Aged, Blind, and Disabled pathway or a Medicare Savings Program tier, not through the MAGI expansion group, because Medicare enrollees are generally 65 or older or already disability-qualified.
Common Reasons Applications Get Denied and How to Appeal
Maryland Medical Assistance and Medicare Savings Program applications are most often denied for four reasons: monthly income above the applicable threshold for the specific category, missing or incomplete income and identity documentation, applying for a Medicare Savings Program before Medicare Part B enrollment is active, and, for full Medical Assistance long-term care cases only, countable assets above the limit (Medicare Savings Programs themselves have no asset test in Maryland). A denial letter must state the specific reason and the regulation it relies on.
Maryland applicants who disagree with a denial have the right to request a state fair hearing, generally within 90 days of the notice date, by contacting the Maryland Office of Administrative Hearings or the number listed on the denial letter. Coverage can sometimes continue during the appeal if the request is filed before the denial's effective date. Local Department of Social Services caseworkers and Maryland Access Point, the state's SHIP program, can help gather missing documentation or refile an application that was denied only for a paperwork error.
Maryland Medical Assistance Program Context
Maryland Medical Assistance is the state's formal name for its Medicaid program, administered by the Maryland Department of Health and delivered largely through a managed care program called HealthChoice for most enrollees under 65. Most full-benefit dual eligibles, however, receive Medicaid on a fee-for-service basis or through a specialized long-term care and D-SNP arrangement rather than standard HealthChoice managed care, because HealthChoice historically excludes people who also have Medicare. Maryland Medical Assistance has covered low-income seniors and people with disabilities since Medicaid began in 1965, and the state has steadily added benefits, including the 2023 expansion of adult dental coverage that also benefits many dual-eligible enrollees.
Frequently Asked Questions
What is the income limit to be dual eligible in Maryland in 2026?
There is no single dual eligible income limit because Maryland offers several pathways. The Qualified Medicare Beneficiary (QMB) program, the most common on-ramp, caps monthly income at $1,350 for an individual and $1,824 for a couple in 2026. The Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individual (QI) tiers allow higher income, up to $1,816 for an individual, but cover only the Medicare Part B premium. Full Medical Assistance for aged, blind, and disabled applicants uses a much lower medically needy standard of $350 per month for an individual ($392 for a couple), though spend-down can still qualify higher earners.
What is the difference between full dual eligible and partial dual (QMB, SLMB, QI) in Maryland?
Full dual eligibles qualify for complete Maryland Medical Assistance benefits on top of Medicare, including long-term care, behavioral health, and non-emergency transportation, plus automatic Extra Help for Part D drug costs. Partial duals qualify only for a Medicare Savings Program tier: QMB covers the Part B premium, deductibles, and coinsurance; SLMB and QI cover the Part B premium alone. Partial duals do not get Maryland's full Medicaid benefit package, so they still pay for services Medicare does not cover, such as long-term nursing home stays.
Does Maryland require an asset test for Medicare Savings Programs?
No. Maryland eliminated the asset test for the QMB, SLMB, and QI Medicare Savings Program tiers, so owning a home, a car, or having modest savings does not disqualify an applicant. Only income counts for these three programs. Maryland's full Medical Assistance program for long-term care still applies an asset limit, generally $2,500 for a single applicant in 2026, separate from the Medicare Savings Program rules.
What does Extra Help cover for Maryland dual eligibles?
Extra Help, also called the Part D Low-Income Subsidy, is automatic for Maryland's full-benefit dual eligibles starting the month Medicaid coverage begins. It eliminates the Part D deductible, caps drug copays at a few dollars per prescription, and closes the coverage gap entirely, well below the standard 2026 Part D out-of-pocket cap of $2,100. Partial duals in the QMB, SLMB, or QI tiers can qualify for Extra Help too but must apply separately through Social Security.
Can I enroll in a D-SNP in Maryland?
Yes. Maryland dual eligibles enrolled in both Medicare Part A and Part B and Maryland Medical Assistance can enroll in a Dual Eligible Special Needs Plan (D-SNP), a Medicare Advantage plan built to coordinate both benefits. Maryland D-SNPs typically carry a $0 premium, add extra dental, vision, and hearing benefits, and assign a care coordinator. Many dual eligibles also get a Special Enrollment Period to switch D-SNPs outside the standard Medicare Advantage Open Enrollment Period.
What documents do I need to apply for Maryland Medical Assistance?
Maryland applicants generally need a Medicare card showing Part A and Part B enrollment, proof of income such as a Social Security award letter or pay stubs, a government-issued photo ID, proof of Maryland residency like a utility bill or lease, a Social Security number, and household composition details for anyone else living in the home.
What happens if my Maryland Medical Assistance application is denied?
Maryland sends a written denial explaining the specific reason and regulation. Applicants can request a state fair hearing, generally within 90 days of the notice, through the Maryland Office of Administrative Hearings or the contact listed on the denial letter. Coverage can sometimes continue during the appeal if requested before the denial takes effect. A Local Department of Social Services caseworker or Maryland Access Point, the state's SHIP program, can help fix paperwork errors and refile.
Is Maryland a Medicaid expansion state?
Yes. Maryland expanded Medicaid on January 1, 2014, covering adults up to 138% FPL under MAGI rules. Expansion mainly affects Marylanders under 65 without a disability determination; most dual eligibles qualify instead through the separate non-MAGI Aged, Blind, and Disabled pathway or a Medicare Savings Program tier because Medicare enrollees are generally 65 or older or already disability-qualified.
