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).

Key facts:

There were 10.7 million dually eligible beneficiaries enrolled in both programs in calendar year 2013, the most recent year of comprehensive data for both programs. A majority were:

  • female (61 percent),
  • age 65 and older (58 percent),
  • white (57 percent), and
  • had at least one limitation on their activities of daily living (56 percent).

Dually eligible beneficiaries accounted for a disproportionate share of spending:

  • In Medicare, they account for 34 percent of spending and 20 percent of enrollees.
  • In Medicaid, they account 32 percent of spending and 15 percent of enrollees. In 2013, combined Medicare and Medicaid spending on dually eligible beneficiaries totaled $312.4 billion of which Medicaid accounted for $118.9 billion (38 percent).

Learn more

Featured publications

Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries—Health Plan Standards, Challenges and Evolving Approaches

March 2019 |

MACPAC contracted with Health Management Associates (HMA) to examine care coordination requirements for several types of integrated care models: managed long-term services and supports programs that require integration with Medicare Advantage dual eligible special needs plans, fully integrated dual eligible special needs plans, and the Financial Alignment Initiative. This report summarizes the results of HMA’s […]
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The Complex Art of Making It Simple: Factors Affecting Enrollment in Integrated Care Demonstrations for Dually Eligible Beneficiaries

January 2019 |

Dually eligible beneficiaries began enrolling in integrated Medicare-Medicaid plans (MMPs) under the Financial Alignment Initiative (FAI) in calendar year 2013. Under the FAI, the Centers for Medicare & Medicaid Services (CMS) and 10 participating states contracted with MMPs under capitated arrangements to coordinate Medicare and Medicaid benefits. Beneficiary participation has been lower than anticipated. Only […]
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Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid

January 2018 |

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 […]
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