Satisfaction with health care was compared for dually eligible older beneficiaries receiving care in three settings: a managed care organization (MCO) that is at risk for providing Medicare and Medicaid benefits (n = 200); the fee-for-service (FFS) sector in the same ZIP Code (n = 201); and respondents to the national Medicare Current Beneficiary Survey (MCBS) (n = 531). Patients in the MCO were more likely to be highly satisfied in three domains--global quality, access to care, and technical skills--compared with patients in the local and national FFS study groups but fewer were highly satisfied with the interpersonal manner of their providers.