# Medicare vs Medicaid in Utah and Dual Eligibility > Medicare vs Medicaid in Utah: who qualifies, who runs each, what they cover, and how Medicare Savings Programs, Extra Help and D-SNPs help dual eligibles. Source: https://eseniorinsurance.com/learn/medicare-vs-medicaid/ Last updated: 2026-10-26 [Home](https://eseniorinsurance.com/) / [Learn](https://eseniorinsurance.com/learn/) /Medicare vs Medicaid in Utah and Dual Eligibility # Medicare vs Medicaid in Utah and Dual Eligibility Medicare is federal health insurance for people 65 and older and some younger people with disabilities, regardless of income. Medicaid is a joint federal and state program for people with limited income and resources, run in Utah by the Utah Department of Health and Human Services. Some Utahns qualify for both, called dual eligibility, and Medicaid then helps pay Medicare costs. [Call 801-255-5340](tel:+18012555340) · [Call 801-255-5340](tel:+18012555340) ## Let's set the stage The names are one letter apart, so people mix them up all the time. Here is the simplest way I explain it: Medicare is based mostly on age or disability, and Medicaid is based on income and resources. Medicare is the same program in every state. Medicaid has federal rules, but each state runs its own version, so the details for Utah are set by Utah. ## Medicare vs Medicaid side by side | | Medicare | Medicaid (in Utah) | | --- | --- | --- | | Who runs it | The federal government (CMS); Social Security handles most enrollment | Utah Department of Health and Human Services, under federal rules | | Who qualifies | People 65 and older, people under 65 on Social Security disability for 24 months, people with ALS or end-stage renal disease | People with limited income and resources who fit an eligibility group, such as adults, children, pregnant women, and people who are aged, blind or disabled | | Does income matter? | Not for eligibility; higher income raises Part B and Part D premiums | Yes, income and often assets | | What you pay | Premiums, deductibles and coinsurance | Little or nothing for covered services | | Long-term nursing home care | Not covered beyond limited skilled nursing care | Can cover long-term care for people who qualify | | Where to apply | Social Security (ssa.gov) or your local office | Utah Medicaid at medicaid.utah.gov | Sources: Medicare.gov; Medicaid.gov eligibility policy; Utah Medicaid. ## What dual eligibility means If you have Medicare and also qualify for some level of Medicaid help, you are "dual eligible." Medicare pays first for services both programs cover, and Medicaid helps with what is left, depending on which level of help you qualify for. There are two broad groups: - **Full Medicaid benefits plus Medicare.** Medicaid can pay your Medicare premiums and cost sharing and may cover services Medicare does not, such as long-term care. - **Help with Medicare costs only** through a Medicare Savings Program. ## Medicare Savings Programs Medicare Savings Programs are run by the state and help pay Medicare costs for people with limited income and resources. | Program | What it can pay | | --- | --- | | Qualified Medicare Beneficiary (QMB) | Part A and Part B premiums, plus deductibles, coinsurance and copays for Medicare covered services | | Specified Low-Income Medicare Beneficiary (SLMB) | Part B premium | | Qualifying Individual (QI) | Part B premium; funding is first come, first served each year | | Qualified Disabled and Working Individuals (QDWI) | Part A premium for certain working people with disabilities | The 2027 standard Part B premium is pending; CMS publishes it in November. At last year's $202.90 a month, an SLMB or QI approval was worth about $2,435 a year in premiums alone. Income and resource limits change every year and Utah publishes its current figures, so check with Utah Medicaid or call us and we will help you look them up rather than guess. ## Extra Help with drug costs Extra Help is a federal program that lowers Part D premiums, deductibles and copays. If you have full Medicaid, a Medicare Savings Program or SSI, Medicare.gov says you automatically qualify for Extra Help. Anyone else can apply through Social Security. People with Extra Help also do not pay the Part D late enrollment penalty. ## Dual Special Needs Plans in Utah A Dual Special Needs Plan (D-SNP) is a Medicare Advantage plan built for people who have both Medicare and Medicaid. These plans coordinate the two programs and often include extra benefits. In the CMS CY2027 landscape file for Utah, 11 distinct D-SNPs are offered across the state, and Salt Lake, Utah and Davis counties have the most special needs plan choices, 18 each. Dual eligible beneficiaries also have more chances during the year to change plans than most people with Medicare, under Medicare's Special Enrollment Period rules. ## A Utah example Here is an illustrative example, not a real client. A widow in West Jordan lives on a modest Social Security check and has a small savings account. She has Medicare Parts A and B and pays the standard Part B premium out of her check each month. If she qualifies for SLMB, Utah pays that premium instead, her Social Security deposit goes up, and she automatically gets Extra Help with her prescriptions. That is real money every month, and it starts with one application. ## Can you have Medicare and an ACA Marketplace plan? Generally no. HealthCare.gov says it is against the law for someone who knows you have Medicare to sell you a Marketplace plan, and you cannot get a premium tax credit once you are eligible for premium-free Part A. Medicaid is different: you can apply for it any time of year. If you are under 65, see [ACA Marketplace in Utah](https://eseniorinsurance.com/learn/aca-marketplace-in-utah/) . ## Special needs plan choices by county for 2027 Special needs plans include plans for people with Medicare and Medicaid (D-SNPs), plans for certain chronic conditions, and plans for people in institutions. Counts below include all special needs plan types. | County | Special needs plans, 2027 | Regular Medicare Advantage plans, 2027 | | --- | --- | --- | | Salt Lake | 18 | 28 | | Utah | 18 | 28 | | Davis | 18 | 28 | | Weber | 17 | 24 | | Tooele | 13 | 15 | | Washington | 11 | 13 | | Wayne | 4 | 0 | | Daggett | 3 | 0 | Source: CMS CY2027 Medicare Advantage and Prescription Drug Plan Landscape, Utah rows. Statewide, 11 distinct D-SNPs, 5 chronic condition plans and 2 institutional plans are offered. ## What you pay with each level of help | Cost | Medicare only | With SLMB or QI | With QMB | | --- | --- | --- | --- | | Part B premium (2027 amount pending, CMS publishes it in November; $202.90 a month in 2026) | You pay | State pays | State pays | | Part B deductible (2027 amount pending; $283 in 2026) and 20% coinsurance | You pay, or your Medigap plan | You pay, or your plan | Covered; Medicare providers may not bill you for them | | Part D costs | You pay | Extra Help lowers them | Extra Help lowers them | The QMB protection matters. Federal rules say providers who accept Medicare may not bill a QMB member for Medicare deductibles, coinsurance or copays. If you are in QMB and get one of those bills, show your Medicaid card and tell the office you are a Qualified Medicare Beneficiary. ## How to apply in Utah 1. Gather proof of income (Social Security award letter, pensions), bank statements and your Medicare card. 2. Apply through Utah Medicaid; start at medicaid.utah.gov for the current application options. 3. Answer any follow up requests quickly. Missing paperwork is the most common reason applications stall. 4. When you are approved, watch your Social Security deposit. If the state pays your Part B premium, your check goes up. 5. Call us to review your plan. Dual eligible people can change plans more often than others, and a D-SNP may fit better than your current plan. ## Medicaid and long-term care Here's the thing many families learn too late. Medicare covers skilled nursing care for a limited time after a qualifying hospital stay, up to 100 days per benefit period, with a daily coinsurance for days 21 to 100. The 2027 amount is pending until CMS publishes it in November; it was $217 a day in 2026. It does not pay for long-term custodial care, the help with bathing, dressing and eating that most nursing home residents need. Medicaid is the main public program that pays for that care for people who qualify. If a parent may need nursing home care, talk with Utah Medicaid and an elder law attorney early, because the financial rules are detailed. ## How we help We are licensed insurance agents, not the state Medicaid office, and we do not decide Medicaid eligibility. What we do: help you see whether a Medicare Savings Program or Extra Help is worth applying for, point you to the right Utah office, and once you have a decision, compare Medicare Advantage plans against your doctors and drugs. ## Frequently asked questions **What is the main difference between Medicare and Medicaid?** Medicare is federal health insurance based mainly on age 65 or disability, regardless of income. Medicaid is a state and federal program based on limited income and resources. In Utah, Medicaid is run by the Department of Health and Human Services. **Can you have both Medicare and Medicaid in Utah?** Yes. People who qualify for both are called dual eligible. Medicare pays first, and Medicaid can help pay Medicare premiums and cost sharing depending on the level of help you qualify for. **What is a Medicare Savings Program?** It is a state program that helps pay Medicare costs for people with limited income and resources. Depending on the level, it can pay the Part B premium (the 2027 amount is pending until CMS publishes it in November; it was $202.90 a month in 2026) and, for QMB, Medicare deductibles and coinsurance too. **How many D-SNP plans are in Utah for 2027?** The CMS CY2027 landscape file lists 11 distinct Dual Special Needs Plans offered in Utah. Which ones you can join depends on your county and your Medicaid level. ## Sources 1. [Medicare.gov: Medicaid and Medicare (dual eligibility)](https://www.medicare.gov/basics/costs/help/medicaid) 2. [Medicare.gov: Medicare Savings Programs](https://www.medicare.gov/basics/costs/help/medicare-savings-programs) 3. [Medicare.gov: Help with drug costs (Extra Help)](https://www.medicare.gov/basics/costs/help/drug-costs) 4. [Medicaid.gov: Eligibility policy](https://www.medicaid.gov/medicaid/eligibility-policy) 5. [Utah Medicaid (Utah Department of Health and Human Services)](https://medicaid.utah.gov/) 6. [Utah Medicaid: Medicare and cost-sharing programs (form 05-985)](https://medicaid.utah.gov/Documents/pdfs/05-985%20Medicare%20and%20Cost-Sharing%20Programs.pdf) 7. [HealthCare.gov: Medicare and the Marketplace](https://www.healthcare.gov/medicare/medicare-and-the-marketplace/) Updated October 26, 2026 by the Everything Senior Insurance Data Desk. ## Keep reading - [Medicare Learning Center for Utah: Guides and Answers](https://eseniorinsurance.com/learn/) - [Who Is Eligible for Medicare? A Plain Guide for Utah](https://eseniorinsurance.com/learn/medicare-eligibility/) - [Medicare Costs in 2027: Premiums, Deductibles and Part D](https://eseniorinsurance.com/learn/medicare-costs/) - [Medicare Late Enrollment Penalties for Parts A, B and D](https://eseniorinsurance.com/learn/medicare-late-enrollment-penalties/) - [Medicare advantage](https://eseniorinsurance.com/medicare-advantage/) - [Part d](https://eseniorinsurance.com/part-d/) - [Medicare in Utah: 2027 Plans by County](https://eseniorinsurance.com/utah/) ## Call 801-255-5340 Call 801-255-5340 or reach us online. [Call 801-255-5340](tel:+18012555340) --- Everything Senior Insurance · Draper, UT · [801-255-5340](tel:+18012555340) · info@eseniorins.com · Agency NPN 18240955 We do not offer every plan available in your area. Currently we represent 95 organizations which offer 3,742 plans nationwide. Please contact Medicare.gov or 1-800-MEDICARE. Not connected with or endorsed by the U.S. government or the federal Medicare program. Everything Senior Insurance is a DBA of Christian Brindle Insurance Services.