posted by AHIP
on September 14, 2018
Medicare and Medicaid play important roles in the lives of millions of Americans. Medicare pays for health care for about 59 million people and Medicaid provides care and services to more than 75 million. While millions of people are entitled to coverage under both programs, their care is uncoordinated and fragmented between two programs that were not designed to work together.
Approximately 12 million people have both Medicare and Medicaid. As compared with typical Medicare enrollees, these “dual eligibles” have more chronic conditions, greater levels of disabilities, mental and physical impairments, and are more likely to need nursing home care.
Managed care plans serve dual eligible individuals through several delivery models that integrate Medicare and Medicaid benefits: dual eligible special needs plans (D-SNPs), Medicare-Medicaid Plans (MMPs) and Programs of All-Inclusive Care for the Elderly (PACE).
Medicare and Medicaid have been critical parts of the American healthcare landscape for more than fifty years. As of 2018, the two programs provide health coverage to more than 134 million people[i] (about 40% of all Americans). Despite the maturity of these programs, there is a group of individuals—people with both Medicare and Medicaid—who rely on the two programs but who experience their care as uncoordinated, fragmented, and at times confusing. This brief provides information about Medicare-Medicaid “dual eligible” individuals, their demographics and impacts on the two public health programs, the service delivery models currently in place to integrate their care, and the role managed care plans play in serving them.