Peripheral artery disease (PAD) refers to atherosclerosis of the lower extremities and is often accompanied by a variety of deleterious effects on a patient's life and limbs. It is estimated to affect up to 10% of the United States population, or roughly more than 6.5 million people (1). Of those with PAD, up to 20% progress to chronic limb-threatening ischemia which can often require revascularization procedures or eventual amputation in a smaller percentage of patients, which significantly worsens quality of life. Multiple studies have evaluated the effects of social determinants of health (SDOH) such as insurance status, education, income, and geographical influences on PAD presentation, treatment, and outcomes. Studies have shown that after accounting for other factors, patients with Medicare or Medicaid were less likely to undergo bypass procedures, more likely to undergo lower extremity amputations, and had worse odds of in-hospital outcomes including mortality compared to those with private insurance (2).

While Medicare enrolls over 83.1 million people, and Medicaid 76.3 million as of June of 2021 (3), a significant portion of the population qualifies for enrollment in both programs. These “dual-eligible” (DE) beneficiaries numbered 12.3 million as of 2019 and represent a particularly vulnerable portion of the populace (4). To qualify for health insurance benefits from both programs, patients must meet the low-income qualifications for Medicaid as well as the age, disability, or end stage renal disease (ESRD) requirements for Medicare (5). Though the requirements to receive benefits from either program remain the same regardless of DE status, a larger proportion of DE patients qualify for Medicare through disability or ESRD status. Through 2019, 37.5% of DE patients were enrolled in Medicare due to disability and/or ESRD, compared to just 8.0% of those enrolled solely in Medicare (4).

The DE population is one of vulnerability and cost to the healthcare system. DE patients are often afflicted by multiple chronic medical conditions (6), and average annual healthcare costs of DE patients younger than 65 are estimated to be more than four times those of their non-DE counterparts (7).

Although many studies have focused on the role of public insurance status in PAD outcomes, the DE population has been infrequently studied. The goal of this review is to provide a comprehensive resource outlining the DE population as related to PAD.