Less Than 1% of Dual Eligibles Considered “High-Cost” Beneficiaries

From Becker’s Hospital Blog
Written by Bob Herman | April 19, 2012


There are roughly 9 million people who are beneficiaries of both Medicare and Medicaid — also known as dual eligibles — and although it is a costly population, less than 1 percent of dual eligibles are considered to be in “high-cost” categories, according to a recent study in Health Affairs.

The authors looked at the 2007 Medicare Current Beneficiary Survey and the 2007 Medicaid Statistical Information System Summary File for their base of data, and they only focused on public spending of dual eligibles.

The combined average per capita spending on dual eligibles was $29,868 in 2007 — more than four times the per capita spending for non-dual-eligible Medicare beneficiaries. However, these results are averages, and the authors found that not all dual eligibles are “high-cost.”

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In 2007, they found roughly 40 percent of dual eligibles had combined Medicaid and Medicare annual spending that was less than the average $7,226 per capita Medicare costs on non-dual-eligible Medicare beneficiaries.

The study’s authors also found that only a relatively small portion of dual eligibles was responsible for the majority of the population’s total spending, as is the case for healthcare in general. Roughly 80,000 dual eligibles, or less than 1 percent of all dual eligible beneficiaries, were in the highest 10 percent of the spending distribution in both Medicaid and Medicare.

“It is these high-cost dual eligibles who would particularly benefit from initiatives aimed at coordinating care and aligning incentives between the two programs,” according to the report. “That said, high-cost Medicare-Medicaid dual eligibles accounted for only about 4.6 percent of total spending on the population in 2007.”