Dually Eligible Beneficiaries
Dually eligible beneficiaries are people enrolled in both Medicare and Medicaid who are eligible by virtue of their age or disability and low incomes. This is a diverse population that includes people with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities. It also includes individuals who are relatively healthy.
Medicare is the primary payer for acute and post-acute care services. Medicaid wraps around Medicare by providing assistance with Medicare premiums and cost sharing and by covering some services that Medicare does not cover, such as long-term services and supports (LTSS).
Key facts:
There were 12.2 million dually eligible beneficiaries enrolled in both programs in calendar year 2019. In 2019, the most recent year of comprehensive data for both programs, a majority were:
- female (59 percent),
- age 65 and older (62 percent),
- white (54 percent), and
- had at least one limitation on their activities of daily living (49 percent).
Dually eligible beneficiaries accounted for a disproportionate share of spending:
- In Medicare, they account for 34 percent of spending and 19 percent of enrollees.
- In Medicaid, they account 30 percent of spending and 14 percent of enrollees. In 2019, combined Medicare and Medicaid spending on dually eligible beneficiaries totaled $440.2 billion of which Medicaid accounted for $164.3 billion (37 percent).
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Learn More about These Topics
- Eligibility
- Benefits
- Delivery system
- Integrated care for dually eligible beneficiaries
- Financial Alignment Initiative
- Medicare Advantage dual eligible special needs plans
- Program of All-Inclusive Care for the Elderly
- Medicare Savings Programs
Featured Publications
Potential Areas for Comment on CMS Proposed Rule on Medicare Advantage for CY2026
December 12, 2024
Medicare Advantage (MA) dual eligible special needs plans (D-SNPs) are MA plans tailored specifically to the needs of people who are dually eligible for Medicaid and Medicare. As of November 2024, more than six million dually eligible beneficiaries received their Medicare benefits and sometimes their Medicaid benefits through D-SNPs. Currently, D-SNPs are the primary vehicle […]
Optimizing State Medicaid Agency Contracts
June 18, 2024
Chapter 2 explores steps toward better coordination of care for people who are dually eligible for Medicaid and Medicare and makes recommendations for how states can optimize and oversee state Medicaid agency contracts (SMACs) with Medicare Advantage dual eligible special needs plans (D-SNPs). Dually eligible beneficiaries who are eligible for both Medicaid and Medicare may […]
Medicare Savings Programs: Enrollment Trends
June 18, 2024
Chapter 3 examines Medicare Savings Programs (MSPs). People who are eligible for both Medicare and Medicaid may be eligible to receive Medicaid assistance with their Medicare premiums and cost sharing through MSPs. The Commission has had a longstanding interest in MSPs because of their potential to improve access to care for low-income Medicare beneficiaries. The […]
