Medicare covers not only the aged, but people on Social Security disability and who have End-stage Renal Disease. About 20% of Medicare beneficiaries are low-income and therefore also qualify for Medicaid. This “dual-eligible” population historically has been relatively high-cost, accounting for 34% of all Medicare spending. Several years ago CMS launched demonstrations to allow states to create special managed-care programs that incorporated and harmonized Medicare and Medicaid benefits. But there still is a substantial sub-population of dual eligibles in fee-for-service Medicare and a study in Health Affairs looks at trends in spending for this group. (HA Article) The researchers examined data from 2007 to 2015 and looked at overall averages as well as spending for certain sup-groups. There were about 3 million dual-eligibles over 65 and 2.4 million under that age in 2015. Among those over 65, average spending was $13,464 in 2007, $15,917 in 2011 and $15,640 in 2015, so it appears to have plateaued in recent years. In 2007 that average spending was twice that for non-duals and by 2011 it was 2.11 times as much, but by 2015, the average spending difference had dropped to 2.06 as much. This was the result of slower spending growth for dual-eligibles than for the regular Medicare population.
A similar trend was seen for the dual-eligible subgroup under age 65. Average spending on this group rose from $10,336 to $11,018 over the study period with a flattening or slight decline in the most recent years and the same trend of slower year-over-year spending growth. Some of the reason for the relative growth or decline of spending between duals and non-duals was due to different rates of change in inpatient and outpatient spending. Much slower growth in nursing home utilization was also a factor. The number or type of health conditions appeared to have little impact on spending growth rates for either sub-group. In general, the slight decline in spending on the dual-eligible population is good news for the federal and state governments, but the absolute difference is still so large that this populations deserves continued attention. And hopefully, most of these patients eventually end up in a managed care program where substantial savings have occurred and spending levels decline more significantly.