• Sean Libby

The Pandemic’s Hidden Crisis: New Dual Eligible Medicare Members

The COVID-19 Pandemic has created disproportionate employment challenges for the over age 65 population, decreasing financial security, and increasing Medicaid/MSP eligibility in the Medicare Advantage population


An ongoing challenge for Medicare Advantage plans and their members has been the low participation rates in Medicaid, and even more so, the Medicare Savings Programs. These Medicaid benefits are immensely valuable to members – these programs are federally funded and administered by the state to pay for the members Medicare Part B premium. They are also important to MA plans as the capitation rate for members categorized as duals is adjusted upward significantly to cover the additional medical costs associated with low-income members. However, the range of eligible members actually participating in these programs has ranged from bad – 63% of eligible full Medicaid members – to outright atrocious – only 15% of eligible QI members take the benefit. The Covid pandemic has likely both expanded the ranks of members eligible for these benefits and decreased the participation rates. Why? Let’s take a look.


A recent publication by the Commonwealth Fund looked at how COVID-19 impacted employment in the over age 65 population:

“In 2018, prior to the pandemic, more than one in six Medicare beneficiaries, or 10.1 million people, were employed, including 9.0 million beneficiaries age 65 and older and 1.1 million under age 65. During the pandemic, about 11 percent of people 65 and older, or about 1.1 million people, have lost their jobs.”


While there are many factors driving this disproportionate loss of jobs among the over age 65 population, some recent published Senate testimony from the Economic Policy Institute helps to provide needed context:


“Unfortunately, older workers were less likely than many other age groups to be able to telework before the pandemic hit…. Nearly three-fourths of workers ages 65 and older—or over 5 million older workers—are unable to telecommute.”

With telecommuting unavailable to over 74% of over age 65 workers, it is no surprise that a pandemic that drove work to homes took jobs away from that group. These lost jobs, in turn resulted in lower household income and an increase in financial challenges. Again, the Commonwealth Fund:


“The job losses and income reductions among Medicare beneficiaries also could threaten their financial security, resulting in more beneficiaries qualifying for Part D low-income subsidies, Medicare Savings Programs, or even Medicaid.”


So, what does this mean for Medicare Advantage plans? The traditional low rates of Medicaid and MSP participations are exacerbated by a new population gaining eligibility in the midst of a global pandemic. These members are less likely to have family guidance to apply for Medicaid and are not able to access as many community resources that might otherwise point them in that direction. These isolated and newly financially insecure seniors are unaware of the meaningful benefits available to them. To reach this population, a dual eligibility vendor needs two key components:

  1. A predictive algorithm that goes beyond traditional income/geography predictors to find “hidden duals”.

  2. A live-agent driven human-to-human engagement campaign to find these members and provide the necessary assistance to help them apply for the benefits they deserve.

Now, more than ever, it is important that Medicare Advantage plans conduct dual eligible outreach to as many members as possible. While there has been much discussion of helping members keep their Medicaid benefits through the COVID-19 Public Health Emergency, a too often overlooked need is to ensure that every eligible Medicare member has the help they need to get the benefits they deserve.


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