Dually eligible beneficiaries are people enrolled in both Medicare and Medicaid by virtue of their age or disability and low incomes. This population is diverse and includes individuals with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities. It also includes some individuals who are relatively healthy.
Dually eligible beneficiaries receive the same benefits as all other Medicare beneficiaries, but they may receive either full or partial Medicaid benefits. Full-benefit dually eligible beneficiaries receive full Medicaid benefits and may or may not receive help paying their Medicare premiums and cost sharing. Partial-benefit dually eligible beneficiaries only receive Medicaid assistance with their Medicare premiums and cost sharing. The Medicare Savings Programs (MSPs) provide assistance in paying for Medicare premiums and cost sharing for dually eligible beneficiaries who meet specific income and asset thresholds.
There were 10.7 million individuals dually enrolled in Medicare and Medicaid in calendar year 2013. A majority were age 65 and older (58 percent), female (61 percent), and qualified for Medicare because of a disability (52 percent).
Due to their complex health care needs, dually eligible beneficiaries account for a disproportionate share of spending in both Medicare and Medicaid. In Medicare, they represent 20 percent of enrollees but 34 percent of spending. In Medicaid, they represent 15 percent of enrollees and 32 percent of spending. Of the $312.4 billion in total spending on dually eligible beneficiaries by both Medicare and Medicaid in 2013, Medicaid accounted for $118.9 billion, or about 38 percent.
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This publication includes state-level information on state policies for paying Medicare cost sharing for four different provider types. Researchers focused on state regulations and provider manuals rather than Medicaid state plan, which are often not readily available. The table was updated in the summer of 2018.
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