Covering the Dual-Eligible Population
Dual eligibles are persons who qualify, in some way, for both Medicare and Medicaid coverage. Medicare covers their acute care services, while Medicaid covers Medicare premiums and cost sharing, and—for those below certain income and asset thresholds—long-term care and other services.
Currently, there are approximately 9 million dual eligibles in the United States, accounting for:
Dual-eligible beneficiaries' health care services must be coordinated across Medicare and Medicaid, two separately governed and funded programs, each with its own set of covered services, provider fee schedules and networks regulations, and payment policies.
To gain a better understanding of this population, as well as the opportunities and challenges they present to health plans, we've developed the attached whitepaper.