State Profiles for Dual-Eligible Individuals
United States Enrollment and Spending for Dual-Eligible Individuals
Full & partial benefit status, average Medicare/Medicaid spending, & share of Medicare/Medicaid spending & enrollment
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In 2025, 11.9 million people, known as “dual-eligible individuals,” had both Medicare and Medicaid coverage. Dual-eligible individuals receive their primary health insurance coverage through Medicare and some assistance from their state Medicaid program. Medicare is a federal program financed primarily by general revenues, payroll tax contributions, and premiums. Medicaid is operated by states with financing from both states and the federal government and is the nation’s largest public health insurance program for low-income Americans and the primary payer for long-term care. Dual-eligible individuals account for a higher share of spending than enrollment in both the Medicare and Medicaid programs on account of their higher per person costs. Spending data for Medicare includes beneficiaries in traditional Medicare only, since spending data for beneficiaries enrolled in Medicare Advantage plans are unavailable.
Summary of Spending and Enrollment Indicators, United States
| Indicator | Value |
|---|---|
| Summary Text | In 2025, 8.5 million dual-eligible individuals were eligible for the full range of Medicaid benefits not otherwise covered by Medicare (“full-benefit”). Most full-benefit dual-eligible individuals were also eligible for coverage of Medicare premiums and in most cases, cost sharing through the Medicare Savings Programs, which are administered by states. The remaining 3.4 million were eligible for the Medicare Savings Programs, but not full Medicaid benefits (“partial-benefit”). Dual-eligible individuals made up 16% of traditional Medicare enrollees and 14% of Medicaid enrollees in the United States in 2021 but comprised a much higher share of spending (31% of traditional Medicare spending and 29% of Medicaid spending). |
Distribution of Dual-Eligible Individuals by Full and Partial Benefit Status, 2025, United States
| Indicator | Value |
|---|---|
| Full-benefit | 0.72 |
| Partial-benefit | 0.28 |
Estimates include dual-eligible individuals in January. Totals may not equal 100% due to data suppression and rounding.
Source: Data are from the Centers for Medicare & Medicaid Services Medicare Monthly Enrollment (Accessed April 2025).
Average Medicare and Medicaid Spending per Dual-Eligible Individual by Benefit Status (in $), 2021, United States
| Indicator | Group | Value |
|---|---|---|
| Medicare | Full-benefit | 24554 |
| Medicare | Partial-benefit | 19492 |
| Medicare | Medicare or Medicaid Only | 9976 |
| Medicaid | Full-benefit | 19493 |
| Medicaid | Partial-benefit | 2270 |
| Medicaid | Medicare or Medicaid Only | 5929 |
N/A indicates data are not available. New Jersey T-MSIS data exclude nearly all dual-eligible individuals with partial Medicaid benefits and the spending associated with those people. Medicaid spending data for Mississippi and West Virginia are from 2020 due to data quality issues in 2021.
See Medicare Spending Per Dual-Eligible Individual in Traditional Medicare and Medicaid Spending Per Dual-Eligible Individual for more details.
Source: KFF analytic file of merged 2021 MBSF and 2021 T-MSIS data.
Dual-Eligible Individuals as a Share of Medicare and Medicaid Spending and Enrollment, 2021, United States
| Indicator | Group | Value |
|---|---|---|
| Traditional Medicare Enrollment | Dual-Eligible Individuals | 0.16 |
| Traditional Medicare Enrollment | Non Dual-Eligible Individuals | 0.84 |
| Traditional Medicare Spending | Dual-Eligible Individuals | 0.31 |
| Traditional Medicare Spending | Non Dual-Eligible Individuals | 0.69 |
| Medicaid Enrollment | Dual-Eligible Individuals | 0.14 |
| Medicaid Enrollment | Non Dual-Eligible Individuals | 0.86 |
| Medicaid Spending | Dual-Eligible Individuals | 0.29 |
| Medicaid Spending | Non Dual-Eligible Individuals | 0.71 |
Medicare estimates include beneficiaries in traditional Medicare only, since spending data for beneficiaries enrolled in Medicare Advantage plans are unavailable. Medicaid spending data for Mississippi and West Virginia are from 2020 due to data quality issues in 2021. Totals may not equal 100% due to data suppression and rounding.
See Medicare Spending for Dual-Eligible Individuals in Traditional Medicare As a Share of Total Traditional Medicare Spending, Dual-Eligible Individuals as a Share of Medicaid Enrollment, and Medicaid Spending for Dual-Eligible Individuals As A Share of Total Medicaid Spending for more details.
Source: KFF analytic file of merged 2021 MBSF and 2021 T-MSIS data.