The short answer
If you have Medicare and Medicaid, Medicare pays first and Medicaid pays last. Ask your state about QMB, SLMB, QI and QDWI, and apply for Extra Help through Social Security at 1-800-772-1213.
Medicare.gov: Medicare pays first for covered services and Medicaid pays last, after Medicare and any other insurance you have.
QMB is the broadest Medicare Savings Program — it can cover Part A and Part B premiums, deductibles, coinsurance and copayments.
For 2026 Medicare.gov lists the QMB monthly income limit as $1,350 for an individual and $1,824 for a married couple, with a $9,950 individual resource limit.
SLMB, QI and QDWI have higher income limits and narrower benefits; QI must be reapplied for every year.
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The full explanation.
What dual eligibility actually does
If you qualify for Medicare and Medicaid at once, you are "dually eligible." Medicare.gov puts the order of payment simply: "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."
During cancer treatment that order matters more than usual, because Original Medicare has no annual out-of-pocket cap. Part B normally leaves you owing 20% coinsurance on chemotherapy infusions, radiation, scans and oncologist visits, month after month. Medicaid is what stops that 20% from landing on you.
Full Medicaid can also cover things Medicare never does, such as long-term services and supports, and in many states non-emergency rides to appointments.
The four Medicare Savings Programs, by name
Even if your income is too high for full Medicaid, you may qualify for a Medicare Savings Program (MSP), which is run by your state Medicaid agency. There are four, and they are not interchangeable. The figures below are the 2026 limits published on Medicare.gov, and Alaska and Hawaii use higher ones.
- QMB — Qualified Medicare Beneficiary. The broadest. Covers Part A premiums (if you pay one), plus Part B premiums, deductibles, coinsurance and copayments. 2026 monthly income limit $1,350 individual, $1,824 married couple; resource limit $9,950 individual, $14,910 couple.
- SLMB — Specified Low-Income Medicare Beneficiary. Pays your Part B premium only. 2026 income limit $1,616 individual, $2,184 couple; same resource limits as QMB.
- QI — Qualifying Individual. Also pays the Part B premium. 2026 income limit $1,816 individual, $2,455 couple. You must apply again every year to keep it.
- QDWI — Qualified Disabled and Working Individual. Pays the Part A premium for people who returned to work and lost premium-free Part A. 2026 income limit $5,405 individual, $7,299 couple; resource limit $4,000 individual, $6,000 couple.
Apply through your state Medicaid agency, not through Medicare. Find yours in the state directory on Medicaid.gov. Some states count income and resources more generously than the federal figures, so apply even if you are slightly over.
If you get QMB, providers are not allowed to bill you for Medicare deductibles and coinsurance. If a bill arrives anyway, say the words "I am a QMB" and ask them to rebill.
Extra Help, which is where cancer drugs get cheaper
Extra Help (also called the Part D Low-Income Subsidy) lowers what you pay for prescription drugs. If you have full Medicaid, or an MSP, or SSI, you get it automatically. Otherwise you apply.
For 2026 Medicare.gov lists the qualifying limits as income up to $23,940 for an individual or $32,460 for a married couple, and resources up to $18,090 individual or $36,100 couple. With Extra Help you pay a $0 plan premium and $0 deductible, no more than $5.10 for a generic and $12.65 for a brand-name drug at participating pharmacies, and $0 for covered drugs once your total drug costs reach $2,100 for the year.
Apply through Social Security, free, at 1-800-772-1213 (TTY 1-800-325-0778), Monday to Friday 8:00 a.m. to 7:00 p.m. local time, or online at ssa.gov. Have bank statements, tax returns, and any pension, annuity, veterans' or Railroad Retirement statements to hand.
If you are between plans and a pharmacy will not fill an oral cancer drug, ask about LI NET, Medicare's temporary drug coverage for people with Extra Help, at 1-800-783-1307.
Free, unbiased help with all of it
- Your SHIP (State Health Insurance Assistance Program) gives free one-to-one Medicare counseling. Find yours at shiphelp.org or call the national office at 877-839-2675.
- 1-800-MEDICARE, that is 1-800-633-4227 (TTY 1-877-486-2048), for coverage and billing questions.
- Eldercare Locator, 1-800-677-1116, connects you to your Area Agency on Aging for local benefits help.
- Patient Advocate Foundation, (800) 532-5274, for case management when the two programs are arguing over a bill.
Plans built for people with both
If you are dually eligible you can stay in Original Medicare or choose a Medicare Advantage plan. Some states offer plans designed for this situation, including Dual Eligible Special Needs Plans (D-SNPs) and PACE. They can simplify the paperwork, but they also have networks. Before you switch, confirm your oncologist and your treatment center are in that network, in writing.
Work through your own situation
Our Medicare and cancer help center has free worksheets that stay on your own device: a cost estimator, a checklist for confirming your oncologist is in network, a medicine list that shows which part pays for each drug, and the phone number for free Medicare counseling in your state.
Sources
Words to know
Tap any term to see what it means.
Common questions
What does 'dually eligible' mean?
It means you qualify for both Medicare and Medicaid at the same time. This often applies to older adults or people with disabilities who also have limited income and resources.
How do the two programs work together?
Medicare pays first for covered services. Then Medicaid can help pay costs Medicare leaves, such as deductibles and the 20% coinsurance, and may cover some services Medicare does not.
Can Medicaid pay my Medicare premiums?
For people who qualify, Medicaid or a Medicare Savings Program may help pay Medicare premiums, deductibles, and coinsurance, lowering your out-of-pocket costs.
Why does this matter for cancer care?
Cancer treatment can be expensive. Having both programs can greatly reduce what you pay for hospital care, chemo, radiation, and drugs, since Medicaid can fill in many of Medicare's gaps.
What is Extra Help?
Extra Help is a program that lowers the cost of Medicare Part D prescription drugs for people with limited income. Many dually eligible people qualify for it automatically.
Questions to ask your doctor
Being prepared helps you get the most out of your appointments. Save or print these questions.
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Your next step
Your care team's answer depends on your treatment — ask them directly.
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Where to get help with this, by name
A hospital social worker or financial navigator is the best first call if you have one. If you do not, these organisations help at no cost to you.
- Patient Advocate Foundation — (800) 532-5274. Case managers take on insurance appeals, denials and medical debt with you. Free.
- TotalAssist (Patient Advocate Foundation's copay programme, merged with the PAN Foundation in 2026) — 866-512-3861. Help with medication copays, coinsurance and deductibles, insurance premiums, and office-visit and administration charges on the day of treatment, across nearly 150 conditions.
- CancerCare — 800-813-HOPE (4673). Oncology social workers, free counselling and support groups. Limited financial help with transport, home care, child care and lodging for people in active treatment who meet their income guidelines — funding is first-come, first-served, so call to ask what is open.
- Triage Cancer — 424-258-4628. Free legal and financial navigation: insurance, employment rights, disability.
- Blood Cancer United (formerly the Leukemia & Lymphoma Society) — (800) 955-4572. Information Specialists answer questions on treatment, insurance and financial problems.
- HealthCare.gov — 1-800-318-2596. For questions about the external review process — the independent review your insurer is required by law to accept.
Your state Department of Insurance regulates insurers and takes consumer complaints. On Medicare, your State Health Insurance Assistance Program (SHIP) gives free one-to-one counselling. If a specific drug is the problem, ask the manufacturer about its patient assistance programme.
Phone numbers checked 31 July 2026. Programmes and eligibility change — if a number has moved, please tell us.
Plain-language explanation of the published sources cited on this page. AI-assisted, source-checked, not clinician-reviewed.
Sources last checked: 2026-07-31 what this meansLast updated: 2026-08-11Next planned review: 2027-01-31
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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