Individuals who qualify for both Medicare and Medicaid are termed “dual-eligible beneficiaries.” Eligibility is typically based on factors such as age, disability status, and income level. For instance, older adults over 65 with limited financial resources, individuals who have depleted their assets due to healthcare expenses, and people under 65 with significant disabilities may all qualify as dual eligible. This dual enrollment allows for comprehensive coverage, as Medicare serves as the primary payer for medical services, while Medicaid covers additional costs and services not included in Medicare. Healthline+1
The benefits of being dual-eligible include assistance with Medicare premiums, deductibles, and copayments, thereby reducing out-of-pocket expenses. Additionally, Medicaid may offer services beyond Medicare’s scope, such as long-term care and personal care assistance. To apply for dual eligibility, individuals must meet the specific criteria for both programs, which can vary by state. Applications are typically submitted through the respective state Medicaid agency, and eligibility is determined based on the state’s guidelines.
