What is a dual eligible?
Americans who are enrolled in both Medicaid and Medicare are referred to as dual-eligible beneficiaries, or Medicare dual eligibles, or sometimes simply duals.
Dual-eligibles are enrolled in both programs when a Medicare enrollee’s income and assets are low enough to qualify them for Medicaid help in paying for some of the costs of Medicare – or to qualify them for full coverage under both Medicare and Medicaid.
These enrollees are commonly broken into two groups:
- full-benefit dual-eligibles – who have Medicare but also receive benefits under Medicaid
- partial duals – who have Medicare but qualify to have Medicaid help pay for expenses such as Medicare premiums and/or cost-sharing
Full-benefit dual-eligibles can enroll in Dual-Special Needs Plans (D-SNPs), which are the largest category of SNPs (the others are I-SNPs for Medicare beneficiaries who are institutionalized, and C-SNPs for beneficiaries with certain chronic medical conditions, but those account for only a small fraction of all SNP enrollments; most are D-SNPs).
Two bills introduced in the U.S. Senate in 2024 aim to improve access to benefits and care for full dual-eligibles: S.3882 and S.3950.
Read more about dual eligibles.
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