Medicare Coverage Sources: A Beneficiary Snapshot

Here’s a⁣ breakdown of the key⁣ details from the provided text, organized for clarity:

1. Dual-Eligible ⁢Beneficiaries (Medicare ⁢& Medicaid)

* Enrollment: 8.3 million dual-eligible individuals were enrolled in Medicare advantage (68%), while 4.0 million were in conventional Medicare (32%).
* ⁣ Medicaid Support: Medicaid ⁤often covers Medicare Part B premiums⁤ and some cost-sharing.
* Demographics: Dual-eligible individuals are ‍more likely to:
* Have⁢ low incomes
⁢ ⁤* Have⁢ lower education levels
⁢ *⁢ ⁣Report fair or poor health
* Identify as ‍Black or Hispanic
* Be under 65
* ⁤ Benefits: ⁢ Most dual-eligible individuals ⁤qualify for⁤ full Medicaid benefits, including ⁢long-term ⁣care.

2. Traditional Medicare ⁤Beneficiaries⁤ Without⁤ Supplemental Coverage

* Numbers: 3.5 million beneficiaries (6% 13% of those⁢ in traditional ⁣Medicare) lacked supplemental insurance in ⁣2023.
* Financial Exposure: These beneficiaries face full Medicare cost-sharing⁣ (e.g., $1,736 hospital deductible in 2026, copays, coinsurance) and no cap on out-of-pocket ⁢expenses.They also pay the standard Part B premium ($203/month in 2026).
* Income Level: ‍ They ⁤tend to have modest incomes ($20,000 – $40,000), making Medigap premiums unaffordable and⁢ disqualifying them for Medicaid.
* ⁢ Trend: The number of beneficiaries without supplemental ‍coverage is decreasing.It went from 5.6 million (10% 17% in traditional Medicare) in 2018 to 3.5 ⁤million in 2023.
* Reason for Decline: This ⁤decline is ⁤highly likely due to the increasing enrollment in medicare Advantage.

3. Data Sources & Methodology

* The analysis uses data from the centers for Medicare & Medicaid Services (CMS) Medicare Advantage Enrollment files (March 2025).
* ⁢ It builds on previous KFF research: “Medicare Advantage ⁢in 2025: Enrollment Update and Key Trends”.