Around 12 million Americans are enrolled in both Medicare and Medicare—and many dual-enrolled individuals are not receiving the care they need as a result—as reported recently by independent health policy research organization, KFF. The problem is caused by a failure to smoothly integrate the two systems, thus leading to fragmented care, higher costs, and poor health outcomes. As a result of the healthcare gap, both federal and state lawmakers are working to develop, test, and implement a myriad of coverage and financing options to aid some of the most vulnerable members of the population.
Why the Overlap?
It is easy to see how Medicare and Medicare can overlap in many cases. Medicaid covers people with limited income and resources, while Medicare covers disabled people and those aged 65. Many people living with disabilities and seniors have lower income and resources. As reported by the organization, Disability Compendium, there is a sizeable poverty gap in the U.S. To be precise, poverty affects around 11.4% of people without disabilities, and 25.9% of people with disabilities. Meanwhile, around one in three older adults are economically insecure, with incomes below 200% of the federal poverty level—as stated by the National Council on Aging.
Key Takeaways from the KFF Report
The KFF research showed that three in ten dual-eligible individuals are enrolled in a dual-eligible Medicare plan, with most having coordination-only dual eligible special needs plans. These plans must be coordinated with state Medicaid programs. Meanwhile, the enrollment of dual-eligible people in traditional Medicare plans ranges from 30% in states like Hawaii, to 70% or higher in numerous states (including North Dakota, Wyoming, and Maryland).
Challenges Faced by Dual-Eligible People
Individuals who are dual-eligible often face more challenges than their non-disabled counterparts. Some of the most pressing of these issues include having a physical or mental condition, being part of a racial or ethnic minority, and earning a low income. All these factor can make it harder to understand and navigate the complex healthcare system.
Complex and disparate rules in the Medicare and Medicaid systems can lead to greater fragmentation and, ultimately, to patients not getting the care they require. Policymakers are therefore proposing that the role of Medicare Advantage plans be expanded, so that the problem of fragmentation can be reduced or eliminated.
The healthcare gap for dual-enrolled individuals is a pressing issue that demands prompt attention and effective solutions. As federal and state lawmakers collaborate to develop and implement various coverage and financing options, it is essential to prioritize the integration of Medicare and Medicaid systems, streamlining coordination and reducing complexities.
By fostering a more cohesive healthcare approach and expanding the reach of Medicare Advantage plans, government can pave the way towards a future where all Americans, regardless of income, age, or ability, receive the quality care they deserve.
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