The case study series, Challenges Faced by Dual Eligibles, is designed to help policymakers, advocates, beneficiaries, and their families better understand the challenges faced by people with Medicare. Each case study tells the story of a client who called the Medicare Rights Center’s National Helpline seeking assistance. The cases highlight common obstacles and suggest possible solutions.

This case study explores common issues with unintegrated care for individuals dually eligible for Medicare and Medicaid. The challenge of making two types of coverage work together too often falls to the beneficiary and their family/caregivers, providers, and community organizations. However, payers can eliminate some of these challenges through program and plan designs that aim to coordinate and combine Medicare and Medicaid services and payments. Integrated care refers to the coordination of Medicare and Medicaid benefits for dually eligible beneficiaries. Such coordination is most often accomplished through managed care plans and programs that pay for and deliver a person’s Medicare and Medicaid services.