(815) 464-1832
Mon - Thurs: 9:00am - 5:00pm | Fri: 9:00am - 4:00pm
Illinois Life Span Program

Becoming A Dual Medicare-Medicaid Eligible Recipient

Last Updated March 2026

This Fact Sheet is available for download in English and Spanish.

Table of Contents

What is a Dual Eligible?

A Dual Eligible is someone who qualifies for both Medicaid and Medicare. This may look different depending on your circumstances. You may fit into any one of these categories:

  1. Regular fee-for-service Medicaid and traditional Medicare
  2. A combined Medicaid and Medicare plan, called a FIDE-SNP
  3. A Medicaid waiver, Medicaid, and Medicare
  4. Medicaid plus a Medicare Advantage plan

In some cases, a Dual Eligible may also qualify for other plans, including private or military insurance.

Are you an Adults with DD Waiver participant (pulled from the PUNS list) with Medicaid as your only insurance who is now eligible for Medicare?

When you become a Dual Eligible and participate in the Adults with DD waiver (Home-based or CILA), you will become exempt from Medicaid Managed Care and need to notify your Medicaid Managed Care Organization (MCO) to process your disenrollment. You will receive regular fee-for-service Medicaid without a plan. 

Those enrolled in the Adults with DD waiver are NOT eligible for FIDE-SNP dual eligible plans.

Are you a Dual Eligible enrolled in the DRS Home Services Program Waivers?

Dual Eligibles who are enrolled in one of the three Department of Rehabilitation Services (DRS) Home Services Program waivers (Persons with Disabilities, Persons with Brain Injury, or Persons with HIV or AIDS), as well as those in the Supportive Living and Elderly Waivers, have different rules.

For these individuals, there are two enrollment choices:

  1. Regular Medicaid, Traditional Medicare, and a Managed Long Term Services and Supports (MLTSS) plan for waiver services ONLY. This MLTSS plan will only cover waiver services like Personal Assistance, and a few other services such as transportation. Regular Medicaid and Medicare will cover health care.
  2. Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNP). These new plans began January 1, 2026. They provide Medicaid and Medicare together through one plan. They may also provide extra benefits. Find out more about FIDE-SNP here. Additional information on the transition to these plans is available on the HFS website. Illinois previously had plans called MMAIs. These were discontinued January 1, 2026. All individuals in MMAIs have been moved to FIDE-SNP plans or enrolled in regular Medicaid and traditional Medicare.

Steps for those in Regular Medicaid and Traditional Medicare (including all those in the Adults with DD waiver, and most in the DRS Home Services Program waivers)

Most Dual Eligibles in waivers, except those enrolled in a FIDE-SNP, will be in Fee-for-Service (FFS) Medicaid and Traditional Medicare (not a Medicare Advantage plan). These individuals need to: 

  1. Apply to the Illinois Medicare Savings Program online at www.abe.illinois.gov, using this downloadable form, or going to their Public Aid office (called Family Community Resource Center or FCRC). Find your FCRC here: https://www.dhs.state.il.us/page.aspx?module=12 and choose Family Community Resource Center as Office Type. 
    • This program will pay most or all of the Medicare premiums, copays, and coinsurance. How much depends on which category you are in. Most people who do not work are in the Qualified Medicare Beneficiary group.
    • Those individuals who previously received SSI and now receive SSDI as a Disabled Adult Child (based off of a parent’s work record) should be able to qualify for the Medicare Savings Program even if their income is higher than listed due to a special exemption. These individuals should not be in spend-down status.
    • If you are in Spend-down status, you likely will not qualify for a Medicare Savings Program.
    • Individuals who work and receive SSDI based on their own record may or may not qualify for Medicare Savings Programs. We suggest reaching out to WIPA for help.
  1. Select a Medicare Part D plan for prescription coverage. Medicare Part D provides all prescription coverage for Dual Eligibles and is mandatory. Seniors and adults with disabilities can call the Senior Health Insurance Program (SHIP) for help with questions about Medicare at 1-800-252-8966 or Age Options (708-383-0258/1-800-699-9043). Illinois Part D plans are listed here.
    • Make sure you are enrolled in Extra Help, which is a federal program that helps with costs of Part D Prescriptions. Most Dual Eligibles are automatically enrolled in Extra Help. If you do not receive information about Extra Help and a plan card shortly before Medicare begins, you may need to apply for Extra Help.
  1. When scheduling medical appointments, ask beforehand if the provider accepts both Medicare and Medicaid. 
    • If the healthcare provider accepts both forms of insurance, they are not allowed to bill for any balance left on an individual’s account (called balance billing). 
    • If the healthcare provider accepts Medicare only, but not Medicaid, then you must decide: 
      • Will you see the provider/pay the balance due yourself? Note that those who are a Qualified Medicare Beneficiary cannot be balance-billed, even if the provider does not accept Medicaid. Others can be balance-billed. Find out if you are a Qualified Medicare Beneficiary here.
      • Will you look for another provider who accepts Medicare and Medicaid? 

Are you a Dependent Adult Child (DAC) covered by a parent’s insurance from a parent’s employer?

For people covered under an employer or retiree health plan, including adults with disabilities on a parental employer or retiree health insurance plan: 

  • Generally, private insurance will be primary and Medicare will be secondary, but this varies. You can use this tool to find out. Medicaid is always the payer of last resort. 
  • If you choose to see a provider who accepts only your private insurance and Medicare, you may be liable for any balance due. 
  • If you get a prescription from a provider who is not enrolled in Illinois Medicaid, you will only be able to use your private coverage and possibly Medicare Part D to cover it. You can ask your healthcare provider to enroll in the Medicaid computer system, even if they do not accept Medicaid, in order to use your Medicaid coverage.
  • The Affordable Care Act (ACA) allows an adult child up to age 26 to remain on a parent’s insurance.
  • Illinois law allows certain adult children to remain on parental insurance beyond age 26 if disabled under certain conditions. Illinois laws require that for an insurance plan, the insurance company must cover the children of the policyholder up until the age of 26. If the adult child is disabled, the insurer in Illinois (fully insured, not self-insured) must allow the individual to remain on the plan past the age of 26. This law may not apply if you have a self-insured plan, usually from a large companies that can cover their own health costs, even if they use a major healthcare insurer to process their bills. If you have a self-insured plan, your plan is not required to provide continuing coverage for an adult with a disability older than age 26, but some plans still offer this benefit. You can check with your HR Department to learn if this benefit may be possible for you. 

Things to think about when becoming a Dual Eligible

  • What is your current coverage? 
  • What will change? 
  • What can you afford? 
  • What else may not be covered? 
  • What have medical providers shared about possible future medical needs and expenses? 
  • Are new providers (primary care or specialists) needed? 
  • Is the person a tax dependent? 
  • Is the person under age 26? 
  • Can the person stay on a parent’s private insurance after the age of 26?
  • Will there be a penalty if you do not enroll in Medicare?
  • What state and federal requirements do you need to be aware of? 
Return to Fact Sheet Library