Delivery system

Dually Eligible Beneficiaries

Medicare and Medicaid deliver services under fee for service (FFS) and managed care, and many beneficiaries are covered under both arrangements.

Slightly more than half (52 percent) of all dually eligible beneficiaries received their Medicaid benefits through FFS in 2013; slightly less than half were enrolled in some form of managed care. Among full-benefit dually eligible beneficiaries, nearly two-thirds were enrolled in some form of managed care in 2013. They received coverage from comprehensive managed care plans (23 percent) or a combination of limited-benefit Medicaid managed care plans and FFS (40 percent).

The services and populations covered by Medicaid managed care plans vary across states. Comprehensive managed care plans generally include most of the acute care services covered by a state’s Medicaid program, but certain items may be carved out and provided separately under FFS or a limited-benefit managed care plan. Services most often carved out include transportation, behavioral health, and dental services. Each of these stand-alone plans has its own set of providers, covered benefits, and processes that beneficiaries must understand and navigate. For more information on plan enrollment for dually eligible beneficiaries, see the MACPAC issue brief on Medicaid and Medicare Plan Enrollment for Dually Eligible Beneficiaries.