Dual-eligible beneficiaries are people who qualify for both Medicare and Medicaid. In the US, there are about 9 million dual-eligible beneficiaries, including low-income seniors and younger people with disabilities.
The term “dual-eligible” includes individuals who are enrolled in Medicare Part A and/or Part B and receive full Medicaid benefits. Medicare-covered services also covered by Medicaid are paid first by Medicare (Medicaid is generally considered the payer of last resort). Medicaid may cover the cost of care that Medicare may not cover or may partially cover (such as nursing home care, personal care, and home- and community-based services).
The options for people with dual eligibility to receive their Medicare and Medicaid benefits varies by state. In some states, dual eligible individuals receive Medicaid through Medicaid managed care plans, and in others, Medicaid coverage may be fee-for-service. In some states, certain dual eligible individuals can join plans that include all Medicare and Medicaid benefits.