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 ("DSNPs") spans young and old, as well as individuals with physical, mental, and developmental disabilities.

DSNPs 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 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 require more support than they receive from VA health benefits.

Under-Served Seniors

Seniors who struggle economically and qualify for Medicaid.

Disabled Americans

Americans with disabilities on fixed incomes receiving SSDI 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
39% of dual-eligible beneficiaries lived on incomes below $10,000 in 2020, compared to 3% of Medicare-only beneficiaries. 3
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 beneficiaries suffer from depression, compared to 23% of Medicare-only beneficiaries. 4
18% of dual-eligible beneficiaries experience mental illness other than depression, compared to 6% of Medicare-only beneficiaries. 4
84% have multiple chronic conditions. 4
40% of dual-eligible individuals report their health status as "fair or poor," compared to 15% of Medicare-only 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
Medicare-Only Beneficiaries
White / Non-Hispanic (81.6%) Hispanic (6.0%) African-American / Non-Hispanic (7.4%) Other (5.0%)
Dually Eligible Medicare Beneficiaries
White / Non-Hispanic (48.6%) Hispanic (21.1%) African-American / Non-Hispanic (22.4%) Other (7.9%)

Sources:

1 Arnold Ventures: Dual-Eligible Study Fact Sheet
2 Benefits Data Trust: Seniors and SNAP
3 KFF: A Profile of Medicare-Medicaid Enrollees (Dual Eligibles)
4 CMS: MCBS Socio-demographic and Health Characteristics of Medicare Beneficiaries Living in the Community by Dual Eligibility Status PUF 2021

https://www.arnoldventures.org/stories/dual-eligible-beneficiary-fact-sheet
https://bdtrust.org/seniors-and-snap/
https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf