Those Eligible for Medicare and Medicaid Face Twin Challenges

More than 12.2 million low-income Americans receive coverage under both Medicaid and Medicare due to age or disability.

These “dually eligible beneficiaries,” or “duals,” account for a disproportionate share of spending in both of the health care insurance programs, often because of multiple chronic conditions, disabilities and complex needs, including social support needs.

Recent research on the health-related social needs of dually eligible people, such as food insecurity, housing instability or transportation issues, shows how these needs may be linked to health outcomes. Financial limitations and food insecurity, unreliable transportation, loneliness or social isolation, and housing insecurity were associated with higher rates of hospitalizations and emergency department visits. For example, unreliable transportation was associated with 85% more hospitalizations and 68% more emergency department visits among duals.

Medicare and Medicaid are separate programs that maintain independent rules on eligibility and benefits. Because the programs are not designed to work together, duals may experience fragmented or uncoordinated care. For example, dually eligible beneficiaries report difficulty in getting and maintaining eligibility for both programs, confusion about coverage options and available benefits, and the need for help in navigating the programs, among other challenges.