Approximately 12 million Americans enrolled in both Medicare and Medicaid account for a disproportionate share of both programs’ spending while facing substantially greater health, functional and financial challenges than other Medicare beneficiaries, according to two KFF reports published July 15.
The analyses draw on linked Medicare and Medicaid administrative and claims data from 2022 and 2023 for spending and enrollment figures, and the 2023 Medicare Current Beneficiary Survey for demographic and health status figures. Medicare spending estimates include only traditional Medicare beneficiaries, as comparable data for those in Medicare Advantage plans are not available.
Eight takeaways:
1. Approximately 12 million people were enrolled in both Medicare and Medicaid as of the most recent data. Of those, most are “full-benefit” enrollees eligible for Medicaid services not covered by Medicare, including long-term care, vision and dental, while the remainder are “partial-benefit” enrollees who receive help with Medicare premiums and cost sharing through Medicare Savings Programs.
2. Dual-eligible individuals comprise 15% of traditional Medicare beneficiaries but account for 29% of traditional Medicare spending. They also make up 13% of Medicaid enrollment but 30% of combined federal and state Medicaid spending.
3. Forty-four percent of dual-eligible individuals report their health as fair or poor, compared with 15% of Medicare beneficiaries without Medicaid. About half (47%) report having a mental health condition, compared with 24% of Medicare beneficiaries without Medicaid.
4. Nearly half (47%) of dual-eligible individuals report difficulty performing at least one activity of daily living, such as eating, bathing and dressing, compared with 21% of Medicare beneficiaries without Medicaid.
5. Nearly two-thirds (64%) of dual-eligible individuals have annual incomes below $20,000, compared with 9% of Medicare beneficiaries without Medicaid. More than half (52%) are people of color, compared with 18% of Medicare beneficiaries without Medicaid.
6. More than one-third (34%) of dual-eligible individuals are younger than 65 and qualify for Medicare through disability, compared with 6% of Medicare beneficiaries without Medicaid.
7. Almost 5 million Medicare beneficiaries with Medicaid used at least one Medicaid wraparound service in 2021, including long-term care, vision, dental or non-emergency medical transportation. Medicaid is the primary payer for long-term care nationally, covering about 61% of total spending.
8. HR 1, signed into law July 4, 2025, cuts federal Medicaid spending by approximately $911 billion over 10 years. KFF projects about 1.3 million dual-eligible individuals could lose Medicaid coverage by 2034 as a result.
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