This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 15, 2025. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
Dual Eligible
A person who qualifies for both Medicare and Medicaid, receiving benefits from both programs.
Full Definition
Dual eligible individuals are people who qualify for both Medicare (federal program primarily for people 65+ or with disabilities) and Medicaid (joint federal-state program for low-income individuals). About 12 million Americans are dual eligible. They receive comprehensive benefits: Medicare covers primary medical services, while Medicaid may cover premiums, cost-sharing, long-term care, and services not covered by Medicare. Special Needs Plans (SNPs) are Medicare Advantage plans specifically designed for dual-eligible beneficiaries.
Real-World Example
An 80-year-old with limited income qualifies for both Medicare and Medicaid. Medicare covers her hospital stays and doctor visits. Medicaid covers her Medicare premiums and cost-sharing, her nursing home care, and transportation to medical appointments — leaving her with almost no out-of-pocket costs.
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