Dual eligibles may be better able to pay for nursing home care than other individuals. In this article, we’ll define the term “dual eligibles” and explain how it relates to nursing home abuse.

Key Takeaways

• Dual eligibles are individuals enrolled in both Medicare and Medicaid
• Dual eligibility helps individuals pay for costs not covered by Medicare such as Medicare premiums and long-term services and supports
• There are two types of dual eligibles: full benefit dual eligibles and partial dual eligibles
• Dual-eligible nursing home residents and their loved ones are cautioned to be aware of the risk of nursing home abuse 

What Are Dual Eligibles?

Dual eligibles, also called dually eligible individuals, are people who are enrolled in both Medicare and Medicaid. They may be enrolled first in either Medicare or Medicaid, and then qualify for the other one. Dual eligibles are enrolled in Medicare Part A or Part B and also full-benefit Medicaid. 

Dual eligibles are eligible for both Medicare and Medicaid by virtue of their age or disability and low income. This population includes people with multiple chronic conditions, physical disabilities, mental illness, developmental disabilities, or cognitive impairments such as dementia. It also includes relatively healthy individuals. 

In the United States, Medicare is the primary payer for acute and post-acute care services. Medicaid provides assistance with Medicare premiums and covers some services that Medicare does not cover such as long-term services and supports like nursing homes. 

In 2019, there were 12.2 dual eligibles enrolled in both Medicare and Medicaid accounting for 34% of spending and 19% of enrollees to Medicare and 30% of spending and 14% of enrollees to Medicaid. 

Types of Dual Eligibles

There are two types of dual eligibles:

• Full benefit dual eligibles - Have Medicare but receive benefits under Medicaid

• Partial dual eligibles - Have Medicare but qualify to have Medicaid help pay for expenses such as Medicare premiums

Dual Eligibles and Nursing Home Abuse

Currently, Medicare Part A pays only for short-term stays at nursing homes, and only if the patient was formally admitted to the hospital for at least three consecutive days prior for the same illness or a condition related to it. 

Unlike Medicare, Medicaid does cover the costs of a long-term stay at a nursing home. For this reason, dual eligibles are much better positioned to pay for long-term nursing home care than individuals who only qualify for Medicare. 

If you or your loved one is a dual eligible seeking to or currently staying in a nursing home, it is important to be aware of the risk of nursing home abuse. Nursing home abuse is defined as the intentional or unintentional harm and mistreatment of nursing home residents by caretakers. It is a very serious problem, as nursing home residents are in a vulnerable position that can be taken advantage of. Nursing home abuse may result in trauma, medical issues, and even death.

If you believe that you or somebody you care about experienced nursing home abuse, it is recommended to speak to the relevant authorities immediately. You may also desire to speak to a nursing home abuse lawyer to determine whether or not you may have grounds for a lawsuit.