Medicare is the primary payer for dual eligibles, usually covering inpatient and outpatient medical care, lab and X-ray services and durable medical equipment (DME). Everything that Medicare covers for non-dual eligible beneficiaries, it also provides for dual-eligible patients.
The services that Medicare does not cover are provided for dual-eligibles through Medicaid. Coverage varies by state, but Medicaid generally also provides assistance with Medicare premiums, cost-sharing and deductibles as well as services not covered by Medicare such as routine dental care and non-skilled long-term care.
According to the Kaiser Commission on Medicaid and the Uninsured, the majority of dual eligibles receive full Medicaid benefits, while others qualify for more limited assistance with premiums and cost-sharing.
What Happens to Medicaid Under the Affordable Care Act (ACA)?
Are There Examples in the States of Novel Approaches to Managing Dual Eligibles?
Who Are Dual Eligibles?
What Does the Affordable Care Act Do With Regards to Dual Eligibles?
How Is Medicaid Financed?