The number of dual eligible beneficiaries — people who are enrolled in both Medicare and Medicaid coverage — increased from 10.4 million in 2016 to 12.8 million in 2024. And a growing share of them chose a private Medicare Advantage plan rather than a traditional fee-for-service Medicare plan, according to a recent analysis from The Commonwealth Fund.

Dual eligible enrollees typically require more intensive and costly health care than the average Medicare enrollee. To qualify as a dual enrollee, a person must be at least 65 years old or have a qualifying disability or medical condition, have a low income and limited resources. Between 2013 and 2021, the percentage of dual eligible beneficiaries covered by a MA plan more than doubled, from 24% to 51%.

According to AIS’s Directory of Health Plans, the top five insurers with the largest dual eligible memberships — UnitedHealth Group, Humana Inc., Elevance Health, Inc., CVS Health Corp.’s Aetna and Centene Corp. — accounted for almost 75% of enrollment as of June 2024. Six of the top 10 health plans saw double-digit growth year over year, while Aetna reported a membership gain of nearly 90.7%.

Dual eligible beneficiaries in MA plans and in traditional Medicare, on average, reported similar ratings of satisfaction with medical care and Part D prescription drug coverage, the report showed. Most dual eligible beneficiaries were able to get needed care, while a larger percentage of enrollees covered by traditional Medicare experienced delays in care due to cost than those covered by MA.

While all dual eligible enrollees receive standard Medicare benefits, they have many options for their primary health insurance, including traditional Medicare, MA and specialized MA plans for individuals with greater and specific health care needs. A Dual Eligible Special Needs Plan (D-SNP) is the most common type of specialized MA plan by far.

The type of Medicare primary health insurance that dual eligibles chose has changed significantly between 2009 and 2021, according to an Urban Institute analysis. Since January 2009, traditional Medicare has been losing dual eligible beneficiaries in all states, with Hawaii and South Carolina seeing enrollment decrease by over 50 percentage points. As of December 2021, Hawaii, Florida, Tennessee, Alabama, Louisiana, Arizona and New York reported that more than 40% of their dual eligible enrollees were covered by D-SNPs.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.