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).
Click here for our Medicaid 101 series on YouTube.
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
Full-Benefit Dually Eligible Individuals in Medicare Advantage Special Needs Plans
October 29, 2026
The Commission is continuing its work on payment and access to care for individuals who are dually eligible for both Medicaid and Medicare. These beneficiaries are diverse and include individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness as well as relatively healthy individuals. In 2022, […]
Demographic Characteristics of Medicaid Beneficiaries Enrolled in the Program of All-Inclusive Care for the Elderly
July 7, 2026
The Program of All-Inclusive Care for the Elderly (PACE) is a fully integrated care model that provides Medicare and Medicaid services to individuals age 55 or older who meet a nursing facility level of care and can live safely in the community at the time of enrollment. In 2023, approximately 89,659 individuals were enrolled in […]
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 […]