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THE ISSUE

Separate Programs, Many Problems

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THE ISSUE

Medicare and Medicaid 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 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.

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.

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 services and supports
Many have one or more mental health diagnoses

“It’s so difficult, and I have a master’s degree in education. It’s too much. It’s overly complicated. It’s meant that you don’t get the benefit because of the language they use – they’re gatekeepers.”

– Caregiver of a person who is eligible for both Medicare and Medicaid

The lack of coordination and integration between Medicare and Medicaid creates numerous obstacles.

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 also drives expenses.

There must be a better way.

 

%

of people eligible for both Medicare and Medicaid say they have difficulty navigating both programs.