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dual eligible

What is a dual eligible?

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Can I be enrolled in Medicare and Medicaid at the same time?

Can I be enrolled in Medicare and Medicaid at the same time?

People with Medicare and Medicaid are known as dual eligibles – and account for about 20 percent of Medicare beneficiaries (12.1 million people). Learn how that status affects your coverage.

cross-over claim

cross-over claim

A Medicare cross-over is a claim that is sent from Medicare to a secondary insurer – usually Medicaid or a Medigap plan - for payment of Medicare deductibles, co-pays and coinsurance.

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

Read more about dual eligibles.

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