1 year ago

The 12.5 million people who are jointly enrolled in Medicare and Medicaid include some of the poorest individuals in the U.S. with some of the highest health needs, requiring disproportionately high spending from both programs to support them.

Two new KFF analyses examine the demographics of this population as well as the latest data on program enrollment and spending.  These data can help inform federal and state policy discussions about ways to improve coordination and management of care for these individuals.

These Medicare-Medicaid enrollees — sometimes referred to as dually-eligible beneficiaries or dual eligibles — receive their primary health insurance coverage through Medicare and some assistance from their state Medicaid program. (Medicare is a federal program, while Medicaid is jointly funded by states and the federal government.) In 2019, Medicare-Medicaid enrollees comprised 17 percent of the traditional Medicare population but accounted for 33 percent of traditional Medicare spending. They made up 14 percent of the total Medicaid population and accounted for 32 percent of all Medicaid spending.

Virtually all Medicare-Medicaid enrollees have low incomes and very modest savings, but they are otherwise a diverse population. For example, they include some seniors who are in relatively good health, as well as adults of all ages with serious medical, functional and cognitive impairments, including lifelong intellectual and developmental disabilities.

• In 2020, 73% of the 12.5 million people who were enrolled in both Medicare and Medicaid were eligible for full Medicaid benefits, such as long-term services and supports.
• The vast majority (87%) had an income of less than $20,000, and nearly half (49%) were people of color.
• Almost 40% were under age 65 and eligible for Medicare due to disability, and 44% were in fair or poor health.
• Medicare spending per Medicare-Medicaid enrollee in traditional Medicare was substantially higher than per capita spending for other Medicare beneficiaries ($23,235 for full-benefit enrollees and $18,427 for partial-benefit enrollees versus $9,448 for all other Medicare beneficiaries without Medicaid coverage).
• Medicaid spending per Medicare-Medicaid enrollee was more than 7-times greater for full-benefit enrollees than for partial-benefit enrollees ($19,811 versus $2,683), Average spending for all other Medicaid enrollees (those without Medicare) was $5,387.

The two new analyses are:

• A Profile of Medicare-Medicaid Enrollees (Dual Eligibles)
• Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles)

The two new analyses are:

KFF also has a special collection in our State Health Facts database featuring the latest data on the number of Medicare-Medicaid enrollees in each state as well as Medicare and Medicaid spending on these enrollees.