What does medical eligibility mean?

Medical eligibility refers to the determination of whether an individual meets the medical criteria for a specific health insurance plan or program.

* Government-sponsored health insurance programs: Government-sponsored health insurance programs, such as Medicaid and Medicare, have specific medical eligibility criteria that individuals must meet to qualify for coverage. These criteria typically include factors such as income, age, disability, and medical conditions.

* Employer-sponsored health insurance plans: Employer-sponsored health insurance plans may also have medical eligibility criteria, such as requiring employees to meet certain health status requirements or to participate in a wellness program.

* Private health insurance plans: Private health insurance plans typically have medical underwriting criteria, which means that the insurance company evaluates an individual's health status and risk factors to determine whether to offer coverage and at what premium rate.

Meeting medical eligibility criteria is important because it ensures that individuals have access to the health insurance coverage they need. Without meeting the eligibility criteria, individuals may be denied coverage or face higher premium rates.