CMS Findings on COVID 19 and Dual Eligibles

Last week, The Centers for Medicare & Medicaid Services (CMS) released data and commentary shedding light on the disproportionate impact of COVID-19 on “dual eligibles.” While individuals with End Stage Renal Disease had the highest rate of hospitalization, CMS announced that the “second highest rate was among beneficiaries enrolled in both Medicare and Medicaid (also known as “dual eligible”), with 473 hospitalizations per 100,000 beneficiaries.”

The hospitalization of dually eligible Medicare members is reflective of a broader trend in higher infection rates among duals compared to the general Medicare population.

“The snapshot also shows that besides higher hospitalization rates, beneficiaries enrolled in both Medicaid and Medicare have a higher infection rate of COVID-19, with 1,406 cases per 100,000 beneficiaries. By comparison, the coronavirus infection rate for beneficiaries enrolled only in Medicare is 325 cases per 100,000.”

That dual eligibles face disproportionate healthcare challenges is a well-established fact. CMS has reflected this reality for decades with increased capitation paid to Medicare Advantage plans for dual eligibles. The same challenges that have historically driven increased medical expenditures for the dual population are likely behind the increased infection and hospitalization rate CMS has published here. Many of these members face multiple barriers every day to living their healthiest lives. Those same circumstances are likely now contributing to the higher infection and hospitalization rates.

Fortunately, in facing the pandemic the dual enrolled population has the support of both Medicare and Medicaid. However, as many as half of those eligible for Medicaid are not currently enrolled as a Dual. These members face the same Social Determinant of Health barriers, and likely are experiencing similar rates of COVID infection and hospitalization, but without the financial support or the increased range of Medicaid benefits. Finding these Medicare members and helping them to get the benefits they have earned is a central component of our mission here at BeneLynk. We are always available to talk with any Medicare Advantage plans that want to better serve their dual eligible populations.

If you want to chat, please drop us a note today at Sales@BeneLynk.com

About the Author

Sean Libby has been an advocate for seniors, people with disabilities, veterans, and individuals with low income for over 17 years. At BeneLynk, we are committed to helping managed care plans to deliver superior Social Determinant of Health solutions to their members. We are always looking to learn more and would like to hear your ideas on how best to assist members in need. Drop us a note at Sales@BeneLynk.com.