An individual who is eligible for both Medicare and Medicaid services based on age, disability, and income is known as what?

An individual who is eligible for both Medicare and Medicaid services based on age, disability, and income is known as what?

• A. ACOs
• B. Dual Eligibles
• C. HRRP
• D. MCOs

Answer: (B)

Dual eligibility refers to individuals who qualify for both Medicare and Medicaid. Medicare covers people based on age (typically 65 and older) or certain disabilities, while Medicaid provides health coverage for those with limited income and resources. When someone meets criteria for both, they are considered dual eligibles. This status matters because it often requires coordination between two separate systems to manage benefits and costs, potentially bringing additional support for services and out-of-pocket expenses. The other terms refer to different concepts: an Accountable Care Organization is a provider group coordinating care under Medicare; the Hospital Readmissions Reduction Program is a policy penalizing hospitals for avoidable readmissions; and a Managed Care Organization is an entity that delivers and manages comprehensive health services under a health plan.

Dual eligibility refers to individuals who qualify for both Medicare and Medicaid. Medicare covers people based on age (typically 65 and older) or certain disabilities, while Medicaid provides health coverage for those with limited income and resources. When someone meets criteria for both, they are considered dual eligibles. This status matters because it often requires coordination between two separate systems to manage benefits and costs, potentially bringing additional support for services and out-of-pocket expenses. The other terms refer to different concepts: an Accountable Care Organization is a provider group coordinating care under Medicare; the Hospital Readmissions Reduction Program is a policy penalizing hospitals for avoidable readmissions; and a Managed Care Organization is an entity that delivers and manages comprehensive health services under a health plan.