Individuals with certain combinations of needs who enroll in both the state-administered Medicaid program and the federally-administered Medicare program are referred to as dual eligibles. Currently, dual eligibles receive prescription drugs and most long-term care benefits from Medicaid, while they are covered by Medicare for acute benefits such as doctor's visits and inpatient hospital care. (also referred to as Dual-Elibible or Duals) Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) - A program mandated by law as part of the Medicaid program. The law requires that all states have in effect a program for eligible children under age 21 to ascertain their physical or mental defects and to provide such health care treatments and other measures to correct or ameliorate defects and chronic conditions discovered. The state programs also have active outreach components to inform eligible persons of the benefits available to them, to provide screening, and if necessary, to assist in obtaining appropriate treatment.
People with both Medicare and Medicaid.
is a term used to describe an individual who is eligible both for Medicare and for full Medicaid coverage, including nursing home services and prescription drugs as well as payments of Medicare premiums. Some Medicare beneficiaries are eligible for Medicaid payments for some of all of the Medicare premiums, deductibles and co-insurance requirements, but not for Medicaid nursing home or prescription drug benefits. 28 E (Back to Top)
People who are eligible to receive both Medicare and Medicaid benefits.
Persons who are eligible for both Medicare and Medicaid.
(Acrobat/pdf) Persons who are entitled to Medicare (Part A and/or Part B) and who are also eligible for some form of Medicaid benefit.
Persons who are entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid. Full-benefit dual eligible beneficiaries will be automatically enrolled in a Medicare prescription drug plan.
People who are eligible for both Medicare and Medicaid.
Individuals who receive Medicare (Part A and Part B) and also some form of Medicaid assistance. This group includes 1) "Full Medicaid," those receiving full Medicaid benefits (i.e., prescription drugs and nursing home care) and Medicaid coverage of Medicare's financial requirements, and 2) "Buy-Ins," those receiving some level of assistance with Medicare cost-sharing and premiums only.
Someone who is qualified for both Medicaid and Medicare.