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 US population, or roughly 6.5 million people [1]. Of those with PAD, up to 20% progress to chronic limb-threatening ischemia (CLTI), which can often require revascularization procedures or eventual amputation in a smaller percentage of patients, which substantially worsens quality of life. Multiple studies have evaluated the effects of social determinants of health, such as insurance status, education, income, and geographical influences, on PAD presentation, treatment, and outcomes. Studies have found 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 with those with private insurance [2].

Although Medicare enrolled more than 83.1 million people and Medicaid enrolled 76.3 million as of June 2021 [3], a considerable portion of the population qualifies for enrollment in both programs. These dual-eligible (DE) beneficiaries numbered 12.3 million in 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 requirements for Medicare [5]. Although 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 end-stage renal disease status. Through 2019, 37.5% of DE patients were enrolled in Medicare due to disability and/or end-stage renal disease, compared with just 8.0% of those enrolled in Medicare only [4].

The DE population is one of vulnerability and cost to the health care system. DE patients often have multiple chronic medical conditions [6], and the mean annual health care costs of DE patients younger than 65 years 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 studied infrequently. The goal of this review was to provide a comprehensive resource outlining the DE population as related to PAD.