What does Medicare Dual Eligible Mean?

A Medicare "dual eligible" refers to an individual who qualifies for both Medicare and Medicaid, two separate government programs that provide health coverage to specific groups of people.

1. Medicare: Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger people with disabilities and those with end-stage renal disease (ESRD). It consists of different parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
   

2. Medicaid: Medicaid is a joint federal and state program that provides health coverage to people with low income and limited resources. Eligibility for Medicaid varies by state and typically includes certain low-income individuals, families with children, pregnant women, elderly individuals, and people with disabilities.

When someone is considered "dual eligible," it means they meet the criteria for both Medicare and Medicaid. Dual eligible individuals often have complex health care needs and may require assistance with healthcare costs beyond what Medicare alone covers. Medicaid can help cover Medicare premiums, deductibles, copayments, and coinsurance, as well as services not covered by Medicare, such as long-term care.

Being dual eligible can provide individuals with access to a broader range of health care services and help them afford necessary medical care. However, navigating the coordination of benefits between Medicare and Medicaid can sometimes be complex, so it's essential for dual eligible individuals to understand their coverage options and benefits under both programs. Additionally, they may benefit from assistance from Medicare licensed agent or other resources available in their state to ensure they receive the maximum benefits for which they qualify.