Who qualifies as a dual eligible individual in health care?

A dual eligible individual is someone who qualifies for both Medicare and Medicaid. This means that they receive benefits from both programs, which cater to different healthcare needs and financial conditions. Medicare primarily serves individuals aged 65 and older or those with certain disabilities, while Medicaid assists low-income individuals regardless of age. Being dual eligible allows these individuals to access a broader range of healthcare services and benefits, as they can utilize resources from both Medicare and Medicaid to cover their medical expenses.

In contrast, individuals with private health insurance, those who are uninsured, or those with employer-sponsored health insurance do not meet the criteria for dual eligibility, as they are not enrolled in both Medicare and Medicaid. The specific combination of eligibility for both programs is what defines a dual eligible individual.