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Clearing up confusion about ‘dual eligibles’

Liz Seegert
Liz Seegert

Dual eligibles are low-income elderly or disabled people jointly enrolled in both Medicare and Medicaid. The distinctions are sometimes bewildering. It’s easy to confuse which program pays for what, what each agency considers “appropriate” care, what factors go into measuring outcomes and how the separate structures of Medicare and Medicaid affect costs and quality.

There is growing concern about the high costs of dual eligibles and the type of care they receive. The CBO points out that these separate programs, with different payment and approval procedures increases the likelihood that full duals – especially those who have many chronic conditions and functional limitations – will be treated by a variety of health care providers who are not coordinating their care, potentially increasing costs and worsening outcomes.

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