Medicare and NC Medicaid: the MQB programs and how the two fit

Some North Carolinians qualify for both Medicare and Medicaid — often called being “dual eligible.” When that happens, Medicare pays first, and NC Medicaid may help with costs Medicare leaves behind, like premiums, deductibles and coinsurance, plus services Medicare does not cover at all, such as long-term care at home or in a nursing facility.

How Medicaid works for seniors in North Carolina

NC Medicaid is administered by the North Carolina Department of Health and Human Services, and eligibility is decided by your county Department of Social Services — not by an insurance agency. North Carolina expanded Medicaid for adults 19 to 64 on December 1, 2023, but that expansion does not reach people 65 and over; for them, eligibility follows the aged, blind and disabled rules, with an income limit at the federal poverty level and a resource limit of $2,000 for one person. You apply online at ePASS (epass.nc.gov), by phone, or in person at the county DSS; the NC Medicaid Contact Center is 888-245-0179, and applications can take up to 45 days.

Once eligible, how you get Medicaid depends on your situation. Most North Carolinians on Medicaid are in managed-care Standard Plans, but people who also have Medicare are excluded from them and are served through NC Medicaid Direct, the state’s fee-for-service program, with behavioral-health services through the regional LME/MCOs. People with significant mental-health, substance-use, intellectual or developmental disability, or traumatic-brain-injury needs — including dual eligibles on the Innovations or TBI waivers — are served by the Tailored Plans that launched July 1, 2024, which coordinate physical health, behavioral health and long-term services together. Medicare keeps paying first for medical care in either case.

Programs that can lower your costs

• Medicare Savings Programs — the MQB programs. North Carolina labels them MQB-Q (the federal QMB), MQB-B (SLMB) and MQB-E (QI). All three pay the Part B premium ($202.90 in 2026); MQB-Q also covers Medicare’s deductibles, copays and coinsurance. Income and resource limits change each year and are set as a share of the federal poverty level. You apply through your county DSS, and you do not have to be on full Medicaid to qualify.
• Extra Help (Low-Income Subsidy) lowers what you pay for Part D premiums, deductibles and copays. If you qualify for an MQB program or Medicaid you get Extra Help automatically; otherwise apply through Social Security.
• Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for people with both Medicare and Medicaid; they coordinate the two programs, usually at $0 plan premium, and often add extras while keeping your Medicaid benefits intact. They are a large part of the menu in Eastern North Carolina and the rural Piedmont.
• PACE — the Program of All-Inclusive Care for the Elderly — combines Medicare and Medicaid into one program of medical care, day services and support at home for people 55 and over who need a nursing-home level of care. North Carolina has 11 PACE organizations at 14 locations, each serving specific ZIP codes.

Free, unbiased state counseling on all of this is available from NC SHIIP — the Seniors’ Health Insurance Information Program, a division of the North Carolina Department of Insurance, with volunteer counselors in all 100 counties — at 855-408-1212. When you are ready to talk through the Medicare side, we are here at (702) 706-6564.

How we help

We help you understand whether a D-SNP is available and a good fit where you live, how an MQB program and Extra Help could reduce your costs, and how to keep your Medicaid benefits working alongside Medicare. Eligibility decisions rest with your county DSS, NC Medicaid and CMS; our job is to make the Medicare side clear.

ECOS Medicare Solutions is a private insurance agency and is not connected with or endorsed by NC Medicaid, the North Carolina Department of Health and Human Services, any county Department of Social Services, or the federal Medicare program.