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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