Clearing up confusion about those enrolled in both Medicare, Medicaid

dual-eligiblesDual eligibles are low-income elderly or disabled people enrolled in both Medicare and Medicaid. The distinctions are sometimes bewildering. It’s easy to confuse which program pays for what, what each agency considers “appropriate” care, what factors go into measuring outcomes and how the separate structures of Medicare and Medicaid affect costs and quality.

According to the Congressional Budget Office, in 2009, the federal and state governments spent more than $250 billion, combined, on health care benefits for the 9 million dual eligibles. There is growing concern about the high costs of dual eligibles and the type of care they receive. They may be treated by a variety of health care providers who are not coordinating their care, potentially increasing costs and worsening outcomes.

Many states are already struggling to meet current Medicaid demand, and as boomers age, more stress will be placed on an already fragile system. Learn more about dual eligibles and what issues to look for in your state with this tip sheet.

One thought on “Clearing up confusion about those enrolled in both Medicare, Medicaid

  1. Avatar photoRobert Bowman

    Why do designers keep choosing the most vulnerable for care management (translated as cost cutting)? Why not cost cut the Advantaged rather than the disadvantaged? As the Center for Public Integrity has pointed out, insurance companies involved with Medicare Advantage made off with 12 billion more a year for 70 billion because government formulas paid them too much.

    If the government fails in payment formulas for “easy” patients in settings with fewer barriers to care, how does it think it can possibly do well for the most complex patients more commonly found with the most barriers to care?

    More at And the Next Victims of Cost Cutting Are Dual Eligibles at

Leave a Reply