A report from KFF found that nearly half of individuals dually eligible for Medicare and Medicaid in 2020 were enrolled in Medicare Advantage plans (49%), while 51% received Medicare benefits via traditional Medicare.1
Enrollment of dual-eligibles in MA plans during the time period was higher among those ages 65 and older at 53%, compared with 41% of MA enrollees younger than 65. Further, according to the report, MA enrollment for dual-eligibles was greater among historically underrepresented groups such as Hispanics (65%), Black people (54%) and Asian/Pacific Islanders (48%), compared with non-Hispanic white enrollees (41%).1
Medicare coverage for dual-eligibles was also affected by location, KFF said. Dual-eligibles in rural areas were more likely to be covered by a traditional Medicare plan (67%) compared with those in metropolitan locales (48%). The majority of dual-eligibles in micropolitan areas were covered by traditional Medicare, as well, at 67%.1
Dual-eligibles typically deal with more mental and physical health issues, come from diverse ethnic and racial backgrounds, and have lower incomes than their counterparts in traditional Medicare, which all pose challenges to navigating the system and finding care, the report authors noted. “Separate eligibility requirements, benefits, and rules for Medicare and Medicaid may further contribute to what has been described as a ‘fragmented and disjointed system of care for dual-eligibles,’” they wrote.1,2
Lawmakers are looking for ways to make more MA plans available that are tailored to dual-eligibles, although that could result in coverage disruption due to care transitions and network restrictions. The report authors noted that higher enrollment among dual-eligibles designed specifically for them could help address care fragmentation, and their analysis may help “inform consideration of policy proposals that aim to improve coverage and care for this high-need population.”1
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References
- Pena, Maria T., et al. How Do Dual-Eligible Individuals Get Their Medicare Coverage? KFF. July 31, 2023. https://www.kff.org/medicare/issue-brief/how-do-dual-eligible-individuals-get-their-medicare-coverage/
- Cassidy, Scott, Carper, Menendez, Cornyn, and Warner Launch Bipartisan Effort to Improve Care for Patients Jointly Enrolled in Medicare and Medicaid. Bill Cassidy, M.D., Nov. 23, 2022. https://www.cassidy.senate.gov/newsroom/press-releases/cassidy-scott-carper-menendez-cornyn-and-warner-launch-bipartisan-effort-to-improve-care-for-patients-jointly-enrolled-in-medicare-and-medicaid
