Among the key takeaways from the report:

• Just more than half of dual-eligible individuals received their Medicare benefits through traditional Medicare in 2020, while the remainder were enrolled in Medicare Advantage plans.
• 3in 10 dual-eligible individuals were enrolled in a dual-eligible plan, most of whom were in coordination-only dual eligible special needs plans. These plans are designed for dual-eligible individuals and are required to coordinate with state Medicaid programs, with some variation in the specific requirements across states.
• Enrollment of dual-eligible individuals in traditional Medicare ranged from less than 30% in Hawaii and Puerto Rico to 70% or more in Alaska, Delaware, Maryland, Montana, North Dakota, New Hampshire, Oklahoma, South Dakota, Vermont, West Virginia and Wyoming.
• Among dual-eligible individuals, Medicare Advantage enrollment rates were higher among beneficiaries aged 65 and older than those below age 65 (53 % versus 41%) and among beneficiaries who were Black (54%), Hispanic (65%) and Asian/Pacific Islander (48%) than non-Hispanic white beneficiaries (41%).

Dual-eligible individuals tend to have lower incomes, are more racially and ethnically diverse and often face greater mental and physical health challenges than the general Medicare population. This can make navigating the health care system and health care coverage challenging. Separate eligibility requirement, benefits and rules for Medicare and Medicaid may further contribute to what has been described as a "fragmented and disjointed system of care for dual eligibles."

Some policymakers have proposed expanding the role of Medicare Advantage plans that are designed for dual-eligible individuals or a subset of these plans. 

"Higher enrollment among dual-eligible individuals in Medicare Advantage plans designed for this population could potentially address fragmentation challenges between Medicare and Medicaid, though based on current evidence, it is not clear these plans always improve the coordination of care," the report concluded. "In addition, it is not clear how such changes would affect expenditures under both programs. Assessing the potential effects of various coverage arrangements on the experiences of dual-eligible individuals and on Medicare and Medicaid spending is beyond the scope of this analysis but would inform consideration of policy proposals that aim to improve coverage and care for this high-need population."