For dually-eligible individuals, Medicare is their primary insurer and mainly pays for medical services, such as hospital and post-acute care. Medicaid wraps around this coverage, providing varying levels of assistance with Medicare costs and paying for services Medicare does not, such as long-term services and supports (LTSS).
While nearly all Medicare-Medicaid enrollees have low incomes and modest savings, they are a diverse group with respect to age and health status. Most are over 65, but many are not. Some are relatively healthy, and others have significant impairments. A Kaiser Family Foundation (KFF) brief examines these and other enrollee characteristics with several key takeaways:
An updated data book from the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) presents similar personal information. It also highlights trends in enrollment, costs, and utilization among Medicare-Medicaid enrollees. The findings include the following:
Together, the reports underscore the opportunities and challenges to improving outcomes and systems for Medicare-Medicaid enrollees. Policymakers have long expressed interest in doing so, in part because dually-eligible beneficiaries account for relatively large portions of program expenditures. In 2020, they comprised 17% of the Medicare population and 33% of total spending. They similarly accounted for 14% of all Medicaid enrollees and 32% of Medicaid spending. Concerns have also been raised as to how the separate programs create barriers to care coordination and the extent to which this increases costs and worsens health.
Medicare Rights supports thoughtful innovations and urges that any potential solutions be carefully considered. As KFF notes, dually-eligible enrollees have distinct needs and circumstances. They have lower incomes, are more racially and ethnically diverse, and are more likely to be in poor health than Medicare-only enrollees. But while many live with serious physical and mental health challenges, nearly one in four say they are in “excellent” or “very good” health, and more than half have no functional limitations. This heterogeneity makes it critical that reforms are targeted enough to meaningfully strengthen program integration and flexible enough to meet the full range of enrollee needs.
Read the KFF brief, A Profile of Medicare-Medicaid Enrollees.
Read the MACPAC and MedPAC data book, Beneficiaries Dually Eligible for Medicare and Medicaid.
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