Dual Health Insurance Still Not Enough

Health insurance

About 9 million Americans have dual health insurance from the federal government, according to the Kaiser Family Foundation, and for many of them, it still is not enough to meet their healthcare needs. These individuals are known as dual eligibles, because they qualify for both Medicare and Medicaid.

Dual eligibles are entitled to Medicare Part A and/or Part B and for some form of Medicaid benefit. To qualify for this two-fisted health insurance, individuals must have low incomes and be disabled or older than 64. Compared with other citizens, dual eligibles tend to be poorer, less educated, and have more health problems, and they are more often women or minorities.

The Medicare Program provides hospital insurance under Part A and supplementary health insurance under Part B. Coverage for Part A is automatic for people age 65 or older and for certain disabled individuals. People with Medicare who have limited income and resources may get assistance for out-of-pocket medical expenses from their state Medicaid program.

For people who are eligible for full Medicaid coverage, Medicaid supplements their Medicare coverage by providing services and supplies available under their state’s Medicaid program. When there are services that are covered by both programs, Medicare pays first, and the difference is made up by Medicaid, up to the state’s payment limit. All of this adds up to some very expensive health insurance coverage: dual eligibles cost up to $200 billion annually.


To put this into perspective, in 2005 this dual health insurance coverage cost almost 50 percent of the $287 billion the US government paid out on Medicaid for the entire nation. Yet only 18 percent of people enrolled in Medicaid also qualify for Medicare. Nearly one-third of the Medicaid budget each year is used up by the 1.6 million dual eligibles, because they need the most care. According to the Kaiser Family Foundation, most of these individuals are in “fair or poor” health, and more than 20 percent live in a long-term care facility.

Yet even this double dose of health insurance coverage is not enough for many people. For an example, we can turn to Oregon, which has 55,000 dual eligibles. According to The Oregonian, a research study showed that 14.4 percent of dual eligible Oregonians at some point could not get the health care they needed, and that 28.7 percent could not afford their prescriptions.

Another problem is access to physicians, since not all doctors or health plans will accept new patients who have Medicare or Medicaid, or they limit the number of patients they will see. People who are newly disabled face hurdles as well: they must wait five months to get Social Security disability and then two more years to get Medicare, for a total of 29 months to get full health insurance coverage.

The disproportionate amount of federal monies paid out on dual eligibles is just one more flag to wave in the current health insurance reform debate. What changes can people who receive benefits from both programs expect to see? How long can Americans afford to keep paying for such an expensive dual program?

Centers for Medicare and Medicaid Services (CMS)
The Kaiser Family Foundation/The Kaiser Commission on Medicaid and the Uninsured
The Oregonian 8/19/09