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).
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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
Comment Letter: Proposed Rule on Policy and Technical Changes to Medicare Advantage for Contract Year 2027
January 27, 2026
MACPAC submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) in response to proposed rulemaking on policy and technical changes to Medicare Advantage for Contract Year 2027. Medicare Advantage (MA) dual eligible special needs plans (D-SNPs) have been a particular area of focus for the Commission, given their widespread availability, the […]
Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid
December 2, 2025
Dually eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of age or disability and low income. The design of the programs creates particular challenges for efficient, effective health care delivery. The existence of separate funding streams can create barriers to coordination of care for dually eligible beneficiaries, which in turn can lead to […]
Inventory of Evaluations of Integrated Care Programs for Dually Eligible Beneficiaries
February 7, 2025
Integrating care for beneficiaries dually eligible for Medicare and Medicaid is a key priority for states and the federal government. This population has varying medical needs, must navigate two different programs for its coverage, and accounts for a disproportionate share of spending in both programs. A variety of models have evolved that seek to better […]