Medicaid and Marketplace: The Dual-Market Approach

By Elizabeth Lund

Many state plans are implementing policies to increase insurer participation in Medicaid managed care and Marketplace programs. This dual-market approach can expand access to affordable healthcare, improve health outcomes and create a more integrated and efficient healthcare system. 

Offering Medicaid and Marketplace Plans

Dual-market participation is increasing because it leverages the strengths of Medicaid and Marketplace programs to benefit consumers and insurers alike.

By offering both, states help to ensure continuity of care for individuals who may need to move from Medicaid to Marketplace coverage. Remaining with the same insurer and provider network creates a smoother transition. Dual coverage also facilitates consistent healthcare access because it reduces individuals’ potential coverage gaps while also coordinating coverage when some family members qualify for Medicaid and others for Marketplace.

Furthermore, dual participation increases options for plans that fit consumer needs and budgets while helping to retain members who might otherwise drop coverage when they’re no longer Medicaid-eligible.

There can be economic advantages, too. States can leverage existing infrastructure – current provider networks, care management programs and administrative systems – to offer competitive Marketplace plans. This can provide consumers with more affordable options, create more competition, and lead to lower premiums and market stabilization.