Two KFF Analyses
Explore the Demographics of People Jointly Enrolled in Medicare and
Medicaid As Well As Program Enrollment and Spending for This Population
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.
Key findings from the
two analyses include:
- 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:
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.
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