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Medicare and Medicaid: Dual eligibility. A person may be eligible for both Medicare and Medicaid, which makes them dually eligible. This article looks at the rules, qualifying criteria, and more.
[1] [2] Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. [3] Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. [4] Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries. [5]
Medicare and Medicaid are different government-funded healthcare programs. To be eligible for both, a person will need to qualify for either partial-dual or full-dual coverage.
Medicare is the federal health insurance program in the United States for people age 65 and older. Medicaid is a joint federal and state program to help people with limited resources or income pay ...
The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. Some people are eligible for both Medicaid and Medicare and are known as Medicare dual eligible or medi-medi's.
The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a ...
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
A study found that in 2009, uninsured patients presenting in U.S. emergency departments were less likely to be admitted for inpatient care than those with Medicare, Medicaid, or private insurance. [69] 60 Minutes reported, "Hospitals charge uninsured patients two, three, four or more times what an insurance company would pay for the same ...