• Posted October 14, 2024

Long-Term Care Out of Reach for 6.5 Million 'Near Dual' American Seniors

About 6.5 million “Near Dual” seniors are struggling to afford long-term care as they grow older and more frail, a new study warns.

“Near Dual” seniors are those who are eligible for Medicare but are only at the cusp of eligibility for Medicaid, the federal/state insurance program for the poor, researchers said.

Medicaid covers long-term care for seniors; Medicare does not.

But to become eligible for Medicaid, seniors must essentially spend themselves into poverty.

Only 6% of Near Duals drained their finances enough to transition to full dual-eligible status between 2017 and 2020, researchers found. 

These people will likely struggle to manage their long-term care unless government action is taken, researchers said.

Near Duals usually have a similar number of chronic illnesses and mobility limitations as those who have both Medicare and Medicaid coverage, researchers noted. 

“This research exposes a critical gap in our current system of funding long-term care,” said Dianne Munevar, vice president of health care strategy at NORC at the University of Chicago. “As a growing number of Americans reach older age, future policy should be informed by data around the needs of the most vulnerable older adults.”

For the study, researchers analyzed Medicare enrollment, claims and survey data to figure out how many people are Near Dual and how often they transition to full coverage from both programs.

Near Dual seniors have $11,000 to $28,000 in annual income, and less than $26,000 in total assets, the report says.

Those finances can’t come close to the annual cost of an assisted living facility ($51,600), home health aide ($55,000), or a private room in a nursing home ($105,850), the report says.

The research team offered four policy solutions that could help these folks better afford long-term care:

• Expand Medicare to provide long-term care for seniors based on their needs

• Provide incentives for states to expand eligibility for Medicaid

• Increase funding for home repair and modification programs, to help seniors stay in their homes longer

• Fund community-based programs that directly support vulnerable older adults

“Nearly 7 million older adults live in a perilous financial situation, which can be hazardous to not just finances, but health care and access, too,” Narda Ipakchi, vice president of policy at The SCAN Foundation, said in a NORC news release.

“Real policy change and relief for Near Duals is urgently needed so they can receive the necessary long-term care needed to age in their homes, safely and surrounded by community,” Ipakchi added.

The study results were published Oct. 10 in the NORC report Housing & Health Care Policy Solutions for Middle-Market Older Adults.

More information

The National Institute on Aging has more about long-term care.

SOURCE: NORC, news release, Oct. 10, 2024