What changes are coming for dual-eligibles in 2024? 

Last year, more than 12.5 million people were enrolled in both Medicare and Medicaid. Over 4.1 million of these beneficiaries have enrolled in a Medicare Advantage D-SNP, a special needs plan offered in some states to dual-eligibles. 

Dual-eligible beneficiaries have access to Medicare benefits for most of their preventive, primary, and acute health care, as well as prescription drugs. As their secondary payer, Medicaid covers long-term care and certain behavioral health care services, and it assists with Medicare premiums and cost-sharing expenses. 

You might be eligible for full or partial dual eligible benefits if you meet the income level and resource requirements set by your state of residence. Every year, Medicare and Medicaid make changes to coverage and enrollment requirements, so it’s a good idea to stay informed about differences you might be facing in the new year. 

What changes are coming up for dual-eligible recipients in 2024? 

In the fall of 2023, CMS announced that there would be several changes for dual-eligibles in 2024. These changes include the following: 

Risk adjustment in the Final Rule 

The Final Rule affects how CMS manages health care programs and how beneficiaries can access their health care services. Its goals include improving access to health care, quality of health care, and health equity by adding a health equity index reward to the Star Ratings Program. This addition will create a greater incentive to provide quality care for patients with social risk factors that can include:

  • Low-income subsidies
  • Dual eligibility status 
  • Disabilities 

Base rates are going to be risk-adjusted according to a set risk score which will account for the health condition, age, gender, dual eligibility status, and demographics of the beneficiary. 

Care integration 

In 2024, CMS plans to integrate care for dual-eligibles through Special Needs Plans (SNPs). Plans called Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs) cover Medicaid benefits like behavioral health care services. Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) cover all Medicaid benefits apart from carve-outs announced in 2024. 

Telehealth coverage 

You will still be able to access Telehealth care services from any location within the United States, including your own home until the end of 2024. On January 1, 2025, you must access Telehealth services from a medical office or facility that’s located in a rural area, except for mental health care services. 

Having access to both Medicare and Medicaid is vital for millions of people in this country. If you aren’t sure whether you qualify for dual eligibility, you should contact a local CMS office in your service area or visit the official CMS website for more information. 

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