Who We Help

People generally become eligible for both Medicare and Medicaid because they are low-income and are over the age of 65 or are disabled. The dual-eligible population eligible for Dual Special Needs Plans ("DSNP") span young and old, as well as individuals with physical, mental, and developmental disabilities.
The DSNP plans offer more extensive benefits to low-income seniors and people receiving Social Security Disability payments than are available through Medicaid or Medicare alone. The U.S. has more than 12 million people who are eligible for these Dual Special Needs Plans and qualify for additional benefits in, available in Medicare Part C and Medicare Advantage plans.
Unfortunately, less than 25% of these eligible Americans are taking advantage of additional benefits through Dual Eligible Special Needs Plans.*
* Kaiser Family Foundation Analysis of CMS Medicare Advantage Enrollment Files 2006-2020
Groups Eligible for Dual Special Needs Plans often include:
Veterans
Veterans who bravely served but don't qualify for VA health benefits​
Under-served
Seniors who struggle economically and qualify for Medicaid​
Disabled
Disabled Americans on fixed incomes receiving SSI payments​
Snapshot of People Eligible for Dual Eligible Special Needs Plans:
Higher-than-average complex care needs and account for a disproportionately high rate of spending for both programs. 1
More likely than their Medicare-only counterparts to experience at least one inpatient hospital stay and visit to the emergency room per year. When surveyed, dual-eligible individuals were three times as likely to report that their health was poor, compared to individuals who are enrolled in Medicare only. 1
49% of seniors on Medicaid are eligible to receive SNAP food benefits. 2
The average annual income for an older dual- eligible is $5,860. 2
These dual-eligible individuals experience high rates of chronic illness, with many having long-term care needs and social risk factors. 1
41% of dual-eligible individuals have at least one mental health diagnosis. 3
49% receive long-term care services and supports (LTSS) Physical and Mental Health Condition Prevalence and Comorbidity among Fee-For-Service Medicare-Medicaid Enrollees. 3
60% have multiple chronic conditions. 3
18% of dual-eligible individuals report that they have "poor" health status, compared to 6% of other Medicare beneficiaries. 4
Dual-eligible individuals experience high rates of chronic illness, with many having long-term care needs and social risk factors. 1
Communities of color are disproportionately represented within this population; thus effective policies must be steeped in an understanding of racial justice. 1
Sources:
1 Arnold Ventures Dual-Eligible Study Fact Sheet
2 Benefits Data Trust
3 Physical and Mental Health Condition Prevalence and Comorbidity among Fee-For-Service Medicare-Medicaid Enrollees. Centers for Medicare & Medicaid Services, September 2014
4 Medicare-Medicaid Enrollee Information, National 2012
https://www.arnoldventures.org/stories/dual-eligible-beneficiary-fact-sheet
https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf