# Medicare Advantage versus Traditional Medicare for Dual Eligible Beneficiaries

> **NIH AHRQ R01** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $398,587

## Abstract

Project Summary/Abstract
Dual-eligible Medicare and Medicaid beneficiaries (“duals”) frequently have complex clinical and social needs.
Compared with non-duals, dual beneficiaries are poorer, more likely to qualify for Medicare due to disability,
and be racial and ethnic minorities. Structuring health benefits to meet the needs of duals is challenging due to
fragmented financing and poor coordination between the two programs. Private Medicare Advantage plans
could be a potentially promising vehicle for better integrating Medicare and Medicaid benefits. Duals are
increasingly enrolling in MA plans with over half (56%) of 12 million duals enrolled in MA in 2022. The relative
value of MA vs. Traditional Medicare (TM) remains uncertain, however, and evidence on differences in care
patterns and outcomes for duals in MA vs. TM is extremely limited. Moreover, because of potential differential
selection into MA, estimating causal effects of MA vs. TM on outcomes is challenging. This study will examine
longitudinal enrollment patterns among Medicaid beneficiaries as they qualify for Medicare, and assess
beneficiary-, county-, and state-level predictors of enrollment in MA vs. TM and enrollment continuity (Aim 1).
To assess the effects of MA vs. TM on utilization and outcomes, we will compare Medicaid utilization and
spending for duals in MA vs. TM, including long-term services and supports (LTSS) and Medicaid-covered
behavioral health services (Aim 2), and Medicare utilization and spending (e.g., prescription drug adherence,
hospitalizations, post-acute care, and mortality, Aim 3). We will use individual-level Medicaid and Medicare
enrollment, claims, and managed care encounter data, 2019-2026, linked with detailed information on county-
level MA plan offerings and state-level policies to accomplish these aims. To estimate the effects of MA
enrollment and address potential selection bias in Aims 2 and 3, we will leverage a natural experiment created
by recent policies that permit automatic enrollment of Medicaid managed care enrollees in MA plans when they
qualify for Medicare. Across all aims, we will assess variation in MA effects for dual beneficiaries who qualify
for Medicare due to disability (<65 years old) vs. age (65+ years old) since disabled beneficiaries are more
likely to use LTSS and behavioral health benefits covered by Medicaid. We will also assess variation in MA
effects by plan features (e.g., level of integration, supplemental benefit offerings). This study supports AHRQ’s
research priority of examining innovative market approaches to care delivery and financing with a focus on
priority populations (e.g., low-income populations, persons with disabilities, and racial and ethnic minorities).
Findings from this study will provide critically needed evidence to inform ongoing state and federal policy
changes to improve care and outcomes for duals in the context of rapidly increasing MA enrollment.

## Key facts

- **NIH application ID:** 10978568
- **Project number:** 1R01HS029664-01A1
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Vicki Fung
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $398,587
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10978568

## Citation

> US National Institutes of Health, RePORTER application 10978568, Medicare Advantage versus Traditional Medicare for Dual Eligible Beneficiaries (1R01HS029664-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10978568. Licensed CC0.

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