THE ISSUE
Separate Programs, Many Problems
THE ISSUE
Medicare and Medicaid are two government programs that were never designed to work together.
Many people find the U.S. healthcare system difficult to navigate. But it’s especially tough for people enrolled in both Medicare and Medicaid.
Just imagine the inefficiency and confusion of having two different insurance cards, contacting different insurers whenever questions come up, and reviewing one directory of physicians for Medicare coverage and another for Medicaid coverage.
And taxpayers end up paying more thanks to inefficiencies in the system that become barriers to savings and lower costs.
THE PEOPLE
For more than 12 million people in America, these challenges are real—and they and their care quality and experiences suffer.
Most people who are eligible for both Medicare and Medicaid are low-income, with complex health and social needs that are among the most expensive to address.
People who are dually eligible are all ages, including 41% who are 65 years of age or younger
Most experience multiple chronic conditions
About half receive long-term care
Many have one or more mental health diagnoses
The lack of coordination and efficient integration between Medicare and Medicaid creates numerous obstacles for people’s care, and taxpayer dollars are wasted on poor-quality care.
Medicare and Medicaid spending on people eligible for both programs rose to $456 billion in spending in 2020.
The complex medical and long-term care needs this population experiences contribute to high costs—but the fragmented and disjointed system of care for people enrolled in both Medicare and Medicaid leads to greater spending and worse outcomes. Closer coordination between the two programs can improve care and reduce the financial burden on U.S. taxpayers.
There must be a better way.
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