Dual eligible describes people who qualify for both Medicare and Medicaid at the same time. If you're dual eligible, you have coverage from two government programs, which together can cover nearly all of your health care costs, often with little or no out-of-pocket spending.
The most common dual eligible scenario is someone age 65 or older with a low income. Medicare provides their primary health coverage (hospital, doctor visits, and prescription drugs), while Medicaid helps cover costs that Medicare doesn't, like long-term care, dental, vision, and Medicare premiums, deductibles, and copays.
You can also be dual eligible if you're under 65 and have both a qualifying disability (for Medicare) and low income (for Medicaid). There are different categories of dual eligibility, "full dual" means you get comprehensive benefits from both programs; "partial dual" means Medicaid helps pay your Medicare premiums and possibly cost-sharing but doesn't provide full Medicaid benefits.
Dual-eligible individuals may also qualify for Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan specifically designed to coordinate Medicare and Medicaid benefits in a single plan, simplifying coverage and care management.
If you or a family member might be dual eligible, it's worth looking into. Many people qualify but don't realize they can access both programs. The combination significantly reduces health care costs, and the coordination between the two programs can simplify access to comprehensive care.
You're dual eligible if you qualify for Medicare (typically age 65+, or under 65 with a disability) AND meet your state's Medicaid income and asset requirements. Contact your state Medicaid office or call us to help determine your eligibility for both programs.
Medicare is the primary payer. It pays first for services it covers. Medicaid then picks up what Medicare doesn't cover, including Medicare premiums, deductibles, copays, and additional benefits like dental, vision, and long-term care.
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