Nearly Two-Thirds of Dual-Eligible Beneficiaries Say Their Health is a Day-to-Day Challenge, According to New Survey

New research from Ipsos and Cityblock Health finds that individuals on both Medicare and Medicaid struggle to access necessary healthcare services and understand their health plan coverage, resulting in delayed care

BROOKLYN, N.Y., June 26, 2025 /PRNewswire/ -- Cityblock Health today announced findings from a new survey of dual-eligible individuals conducted in partnership with Ipsos, aimed at better understanding the experiences of those who are enrolled in both Medicare and Medicaid health plans.

Today, dual-eligible individuals are expected to navigate two unique health plans with differing coverage, often causing confusion, gaps in care, and, as seen in this survey, delayed care. Over the next few years, the dually eligible population is expected to grow by 6% annually, totaling more than 15 million individuals by 2028. As this population continues to grow, this survey asked about daily living situations, perceptions of healthcare benefits, and interactions with healthcare professionals to assess overall experiences faced by this complex population.

Results show that among the 280 dual-eligible individuals surveyed:

Some dual-eligible individuals reported experiencing long wait times for a doctor visit, difficulty accessing their healthcare, and trouble understanding their health plan coverage.

• 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 Dr. Toyin Ajayi, CEO and Co-founder of Cityblock Health. "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."

In 2024, Cityblock Health served 100,000 Medicaid and dual-eligible beneficiaries across seven states, offering a scalable approach to engaging members by connecting with them at every step of their care journey, meeting them where they are, and partnering with community-based organizations to meet social needs. The learnings from this survey support the experience Cityblock Health has seen serving this population for nearly eight years.

"This survey uncovers gaps in our current system that affect not only the benefits of dual-eligible individuals, but the experiences they have in accessing and engaging in their care," said Mike Roaldi, President at Cityblock Health. "With new CMS requirements on the horizon that will require all Medicare-Medicaid Plans (MMPs) to transition to Dual-Eligible Special Needs Plans (D-SNP), health plans and risk-bearing providers have a huge opportunity to address these barriers and provide more support for this population."

Details of the findings are available in Cityblock Health's State of Dual-Eligible Health Experiences report here. For more information on the dual-eligible landscape, read Cityblock Health's annual report here.

About Cityblock Health

Cityblock Health is a value-based healthcare provider focused on the complex clinical, behavioral health, and social needs of dually eligible and Medicaid recipients. Cityblock offers a fully integrated solution that directly delivers clinical care to one of the most at-risk and hardest to reach populations. Powered by advanced technology that provides its care team with a data-driven understanding of member needs and risks, Cityblock has demonstrated industry-leading engagement, member retention, meaningful reductions in avoidable hospital readmissions, and reduced total cost of care. Cityblock currently serves more than 100,000 members, and partners with four of the top five national Medicaid health plans and several health systems in 15 cities across seven states. Cityblock has been named to Fast Company's World's 50 Most Innovative Companies list and consistently ranked among CNBC's Disruptor 50. To learn more, visit www.cityblock.com.

All medical services are provided by licensed physicians and healthcare practitioners employed by Cityblock Medical Practice, P.A. Cityblock Health, Inc. provides management and administrative services to Cityblock Medical Practices.

Survey Methodology

• Sample Design: An online, 20-minute, self-administered, cross-sectional survey among dual-eligible individuals in the United States
• Sample Source: Respondents were recruited from opt-in panels of consumers across the country
• Respondent Qualifications: Known dual-eligible individuals (dual-eligible individuals screened in via their health plan), Income identified dual-eligible individuals (dual-eligible individuals screened in via income and household size)
• Significance: Survey responses are weighted to reflect U.S. Census data on age, gender, and race/ethnicity
• Eligibility: Survey eligibility requires current select or eligibility for dual health plans (a combination of Medicare and Medicaid Coverage). Those not easily identified by health plan status alone must meet the income and household size limits for Medicaid at the national level
• Sample Size: 280 people
• Survey Timing: February 4-March 3, 2025
• Conducted by: Ipsos

SOURCE Cityblock Health