The Unique Needs of Partial Dual Eligible Beneficiaries

June 2021
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Partial dual eligible beneficiaries have medical, social, and functional needs that are similar to those of the full dual eligible population. Partial dual eligible beneficiaries are also likely to experience changes in eligibility throughout the year—moving between no, partial, and full Medicaid coverage. 

Partial dual eligible beneficiaries receive financial assistance for certain Medicare costs, but do not qualify for full Medicaid benefits. As policymakers seek ways to improve integration for people eligible for Medicare and Medicaid, partial dual eligibles often are omitted from these approaches. As a result, they may be left with limited access to programs and products that can improve their health and wellbeing.

With support from the Elevance Health Public Policy Institute, ATI Advisory—a research and advisory firm focused on healthcare and aging—analyzed data from the 2018 Medicare Current Beneficiary Survey and the 2018-2020 Master Beneficiary Summary File to better understand how partial duals compare to full dual eligibles and Medicare-only beneficiaries.

Topics

  • Overview of partial dual eligible beneficiaries
  • Prevalence of social, functional, and medical needs
  • Medicare utilization and spending
  • Rate of churn among partial dual eligible beneficiaries
  • Policy recommendations

Related Public Policy Research

Improving Integration for Dual Eligible Beneficiaries: The Role of D-SNPs
August 2020
D-SNPs offer states a flexible path to advance whole person health and improve health outcomes for individuals who are eligible for both Medicare and Medicaid benefits (dual eligibles).
Understanding the Medicare Advantage Program
October 2017
MA plans provide enrollees a valuable alternative to FFS by offering out-of-pocket cost protections, additional benefits, and innovative strategies for care management and coordination.

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