Medicaid and Medicare Plan Enrollment for Dually Eligible Beneficiaries

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July 2016 | Medicaid and Other Payers

Medicaid and Medicare together provide coverage of medical care and long-term services and supports (LTSS) for approximately 10 million low-income seniors and people with disabilities who are dually eligible for both programs. Policymakers have long had concerns around the lack of coordination between Medicaid and Medicare, and how this can result in fragmented care, high costs, and poor outcomes for these beneficiaries. This issue brief focuses on plan enrollment for full-benefit dually eligible beneficiaries, finding that many beneficiaries are enrolled in three or more plans. The brief also examines enrollment specific to limited-benefit Medicaid managed care, finding that almost half of dually eligible beneficiaries are enrolled in at least one such plan. Moreover, while a special type of plan known as Dual-eligible Special Needs Plans (D-SNPs) is designed specifically to integrate care between Medicaid and Medicare, about 60 percent of D-SNP enrollees also have a limited-benefit plan.

In order to better understand how to improve integration of services and administrative alignment between Medicaid and Medicare, this issue brief examines which plans dually eligible beneficiaries are enrolled in. The analysis uses data from 2011, the most recent year for which data are available.

This issue brief was updated in October 2016 to correct an error in Medicare Advantage enrollment.

Publication Type: Issue Briefs

Tags: administration, behavioral health, benefits, case management, dental care, dually eligible beneficiaries, elderly, enrollment, fee for service, limited benefit plans, long-term services and supports, managed care, people with disabilities, Program of All Inclusive Care for the Elderly (PACE), special needs plans, spending