Dual Eligibles: Medicaid’s Role for Low-income Medicare Beneficiaries

Nearly 9 million Medicaid beneficiaries are “dual eligibles” ? low-income seniors and younger persons with disabilities who are enrolled in both the Medicare and Medicaid programs. Dual eligibles are among the sickest and poorest individuals covered by either the Medicaid or Medicare programs. They must navigate both Medicare and Medicaid to access services, and rely on Medicaid to pay Medicare premiums and cost-sharing and to cover critical benefits Medicare does not cover, such as longterm care. Because dual eligibles have significant medical needs and a much higher per capita cost than other beneficiaries, they are of great interest to both Medicare and Medicaid policymakers and to the state and federal governments that fund and manage the programs.

Dual eligibles account for 15% of Medicaid enrollees. About six in ten dual eligibles (5.5 million) were individuals age 65 and over, and more than a third (3.4 million) were younger persons with disabilities. (Figure 1) Most dual eligibles have very low-incomes: 55% have annual income below $10,000 compared to 6% of all other Medicare beneficiaries. Most dual eligibles have substantial health needs: half are in fair or poor health, more than twice the rate of others on Medicare. Dual eligibles are also more likely to have mental health needs and to live in nursing homes compared to other Medicare beneficiaries. (Figure 2)