Health Outcomes of Dually Eligible Beneficiaries Under Different Medicare Payment Arrangements

AJMC December 1, 2025
Kenneth Cohen, MD, Boris Vabson, PhD, Jennifer Podulka, MPAff, Omid Ameli, MD, DrPH, Kierstin Catlett, PhD, Nathan Smith, PhD, Megan S. Jarvis, MS, Jane Sullivan, MPH, Susan Dentzer, MS

Key Takeaways

• At-risk Medicare Advantage (MA) showed superior quality and efficiency outcomes compared to traditional Medicare (TM) and fee-for-service (FFS) MA for dually eligible beneficiaries.
• The study found significant reductions in avoidable hospital and emergency department visits for Duals in at-risk MA compared to TM and FFS MA.
• Duals in at-risk MA had better outcomes in 17 of 20 measures compared to TM and 18 of 20 measures compared to FFS MA.
• The study supports CMS’s goal of expanding accountable care arrangements, emphasizing the inclusion of at-risk MA for Duals.

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and...

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