Dual-eligibles (persons who are eligible for both Medicare and Medicaid) must be considered differently when health plans are implementing care and quality improvement strategies. Common characteristics among dual-eligibles include: low-income or below the poverty level, 65 years or older, often managing multiple chronic conditions and comorbidities that are physical and mental in nature. As such, dual-eligibles are more likely than other beneficiaries to rely on their health plans for long-term, acute care, or post-acute care services.
So what does that mean for Medicare Advantage Part D (MAPD) plans?
Dual-eligibles represent more than 20 percent of the Medicare population.
Almost 30 percent of dual-eligibles are enrolled in Medicare Advantage programs.
Almost 40 percent of Medicare Advantage enrollees live at or below the Federal Poverty Level (FPL).
Although dual-eligibles make up only about 20 percent of all Medicare beneficiaries, they can be attributed with nearly double that amount (36 percent) of all Medicare spending. Comparably, dual-eligibles account for about 15 percent of Medicaid enrollees but 39 percent of all program costs. MAPD plans must see this unbalance as an indicator of the import and weight of this population.
Combining these statistics with the fact that more than 60 percent of dual-eligibles live at or below the FPL, leaves us with a large proportion of members who are chronically ill, exceedingly poor, and often over- or under-prescribed.
What Dual-Eligible Strategies Need
Approaching the dual-eligible population requires plans to consider alternative methods of prescription management, education, and outreach. They should consider:
- Applying more than just phone interventions.
- Creating strong programs to enact real change with deprescribing.
- Using platforms that streamline administrative activities and member targeting.
Dual-eligible members are part of the broader low-income subsidy (LIS) population: see why and how MAPD plans should focus on this complex group.