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Who is the Dual-Eligible Population and Why is Change Needed?

There are 12.2 million people nationwide who are simultaneously enrolled in Medicare and Medicaid, a population often referred to as “dual-eligible” beneficiaries. This group represents a key opportunity for policymakers who care about government spending and improving care delivery for vulnerable populations.

SPENDING

Why is caring about the dual-eligible population important for the financial sustainability of the Medicare and Medicaid programs?

Individuals who are dually eligible for Medicare and Medicaid tend to have higher-than-average complex care needs and account for a disproportionately high rate of spending for both programs.

In fact, the average total spending for dual-eligible individuals at $30,510 per beneficiary is almost double their Medicare-only counterparts at $15,630 per beneficiary. 

OUTCOMES

Despite high spending, the outcomes experienced by dual-eligible individuals are often poor.

Dual-eligible individuals are more likely than their Medicare-only counterparts to experience at least one inpatient hospital stay and visit to the emergency room per year. When surveyed, dual-eligible individuals were three times as likely to report that their health was poor, compared to individuals who are enrolled in Medicare only.

CONSIDERATIONS

Because the dual-eligible population is not homogenous, their unique circumstances and needs must be taken into account when developing policy solutions.

People generally become eligible for both Medicare and Medicaid because they are low-income and are over the age of 65 or are disabled. This means that the dual-eligible population spans young and old, as well as individuals with physical, mental, and developmental disabilities.

Communities of color are disproportionately represented within this population, thus effective policies must be steeped in an understanding of racial justice.

Dual-eligible individuals experience much higher rates of chronic disease than the average population, necessitating solutions that take their health challenges into account and work to integrate and streamline their care.

Dual-eligible beneficiaries tend to use more health care and need more support than the Medicare-only population. 

SOLUTIONS

To improve care and contain costs for dual-eligible beneficiaries, we believe policymakers must consider three objectives:

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