Survey: Dual Eligibles Struggle With Access, Health Plan Confusion

A new survey of dual-eligible individuals found that some dual-eligible individuals reported experiencing long wait times for a doctor visit, difficulty accessing their healthcare, and trouble understanding their health plan coverage, resulting in delayed care. 

The survey is from CityBlock Health, a value-based healthcare provider focused on the clinical, behavioral health, and social needs of dually eligible and Medicaid recipients. In 2024, Cityblock Health served 100,000 Medicaid and dual-eligible beneficiaries across seven states.

Along with research partner Ipsos, CityBlock conducted the survey to better understanding the experiences of those who are enrolled in both Medicare and Medicaid health plans.

The researchers note that over the next few years, the dually eligible population is expected to grow by 6% annually, totaling more than 15 million individuals by 2028. 

The survey asked about daily living situations, perceptions of healthcare benefits, and interactions with healthcare professionals to assess overall experiences faced by this complex population.

Among the 280 dual-eligible individuals surveyed:

• 24% waited two or more weeks for an appointment with their main doctor, and nearly two out of five patients (38%) waited more than 30 minutes for a medical appointment to begin at least some of the time.

• One in five (20%) said they find their healthcare hard to access.


After a negative healthcare experience or difficulty understanding their coverage, some dual-eligible individuals reported delaying their healthcare or visiting the emergency room as a result.
 
• 42% reported visiting the emergency room (ER) or urgent care at least once in the last year due to dissatisfaction with their doctor.

• 33% said they have delayed seeking healthcare at least once in the last year due to a negative experience with the healthcare system or a doctor.

• A quarter (25%) of dual-eligible individuals say they've delayed seeking care at least once in the past year because they did not understand their health plan.


Dual-eligible individuals also reported struggling with their mental health and indicated that social barriers impact their ability to seek care.

• Dual-eligible individuals reported experiencing sadness (54%), depression (45%) and loneliness (42%) at least monthly.

• 28% said a lack of reliable transportation impacted their access to care at least some of the time.

• 69% reported that money is a day-to-day challenge in their life.

“With nearly two in three dual-eligible patients struggling with their health daily, it's clear that more needs to be done to provide a trustworthy, effective, and longitudinal care experience for this population and prevent costly consequences like avoidable delays in care and unnecessary ER visits,” said Toyin Ajayi, M.D., CEO and co-founder of Cityblock Health, in a statement. “These results underscore the value of outcomes-based care models that take accountability for supporting members in navigating their healthcare benefits and for providing a more tightly coordinated healthcare experience. I'm optimistic about the progress we've seen towards Medicaid-Medicare integration, and I remain hopeful this will continue. These findings shine a light on the need to prioritize comprehensive physical, behavioral, and social care support for one of our nation's most complex and fast-growing populations.”