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Facts about Dual Eligible And Its Beneficiaries

There are more than 9 million Americans that qualify as dual eligible, meaning they receive healthcare benefits from both Medicare and Medicaid. While they account for just 14% of all Medicaid enrollees, they cost Medicaid 36% – $139 billion – of its annual medical expenditures, according to a Kaiser Family Foundation report. This is because the enrollees are among the poorest and sickest people in the country.

Roughly 60% of dual eligible beneficiaries are elderly, age 65 or older. Most, 91%, of older (65 and over) adults who were enrolled in Medicaid became dual eligible as they reached the age for Medicare enrollment. The remaining 9% aren’t eligible because their work history doesn’t qualify them for Medicare coverage. Medicare is the primary provider

The remaining portion of the dual eligible enrollees is comprised of people with a disability under the age of 65. A much larger percentage of them, 60%, are not eligible for Medicare, although a significant percentage will become eligible when the required 2-year waiting period between when they first start receiving Social Security Disability Insurance and become eligible for Medicare expires for them.Quality Patient Care

Dual enrollees are expensive to Medicare and Medicaid and represent the most costly enrollees for both.   Costs to each fluctuates depending on the enrollee’s state’s Medicaid programs. Typically, for dual eligible enrollees seeking elderly healthcare, the average annual Medicaid payout in 2010 ranged from less than $11,000 in some states to more than $28,000 in others. For the disabled group of dual eligible enrollees, the range was less than $7,000 to more than $38,000. The average was $16,460.

For both groups, the lion’s share of Medicaid expenditures go toward long-term care – a total of 65% or $90.3 billion. According to Kaiser, 13% of dual eligible beneficiaries spent some of 2010 in a long-term care setting accounting for nearly half of Medicaid’s payout for dual eligible enrollees and 16% of Medicaid’s total expenditures. Those seeking elderly healthcare spent more time in long-term care than their disabled counterparts.

Medicaid pays out an estimated $34.5 billion for acute care services that are either not covered by Medicare or are a part of the individual’s state Medicaid coverage. Acute care spending is higher for the younger, disabled group than it is for the older dual eligible group.

Another $12.8 billion dollars of Medicaid payouts went toward paying Medicare premiums for those who qualified for the assistance.

Just 1%, or $1.3 billion went toward prescription drug coverage. Medicare covers the vast majority of prescription medications for dual eligible enrollees through Medicare Part D which was first implemented in 2006.

Currently the Center for Medicare and Medicaid Services is working with several states to try to control expenses and improve healthcare for dual eligible enrollees.

For help enhancing and improving elderly healthcare and long-term care of the chronically ill, contact General Medicine, The Post Hospitalist Company.

Tom Prose

CEO at General Medicine, P.C.
As founder and CEO of General Medicine PC, the nation’s premier post-hospitalist care company,Tom Prose leads an exceptional team of internal medicine, geriatrics and healthcare administration specialists.