Hayes Susan L, Byrnes Mary E, Furst Wendy, Beathard Erin, Tipirneni Renuka
Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI, USA.
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
J Gen Intern Med. 2025 Sep 2. doi: 10.1007/s11606-025-09789-9.
The Affordable Care Act expanded Medicaid eligibility for low-income adults who are not Medicare eligible while leaving in place states' more restrictive dual eligibility criteria. When Medicaid expansion enrollees turn 65 and transition to Medicare as their primary insurer, they may lose Medicaid and face higher premiums and out-of-pocket costs, yet there is little understanding of how older adults navigate this change in insurance programs.
To investigate the experiences of Medicaid expansion enrollees who transitioned to Medicare coverage at age 65.
This is an interpretive descriptive qualitative study. Primary data were collected through semi-structured in-depth interviews conducted from April 2022 to February 2023. Data were analyzed in an iterative process, informed by interpretive description, a non-categorical qualitative methodology initially developed to address problems in applied settings.
Participants had to be at least 65 years old, reside in Michigan, and have transitioned from Michigan's Medicaid expansion coverage to Medicare (either traditional or Medicare Advantage) between 2016 and 2022.
Descriptive themes of participant experiences navigating the transition from Medicaid expansion coverage to Medicare.
The study included 30 participants aged 65-71. A majority were women and White, with diverse educational attainment and geographic representation within Michigan. Nineteen participants were Medicare-only (without dual coverage). Three main themes were identified. This change in insurance was (1) unwanted; (2) complicated; and (3) for those without dual coverage, financially burdensome.
Our findings suggest a better alignment of Medicaid eligibility criteria before and after age 65, and access to unbiased Medicare enrollment guidance could help facilitate a smoother transition between these programs.
《平价医疗法案》扩大了对不符合医疗保险资格的低收入成年人的医疗补助资格，同时保留了各州更为严格的双重资格标准。当医疗补助扩大计划的参保人年满65岁并转而以医疗保险作为主要保险时，他们可能会失去医疗补助，并面临更高的保费和自付费用，然而，对于老年人如何应对这种保险计划的变化，人们了解甚少。
调查在65岁时转而参加医疗保险的医疗补助扩大计划参保人的经历。
这是一项解释性描述性定性研究。主要数据通过2022年4月至2023年2月进行的半结构化深度访谈收集。数据采用迭代过程进行分析，以解释性描述为依据，解释性描述是一种最初为解决应用环境中的问题而开发的非分类定性方法。
参与者必须年满65岁，居住在密歇根州，并且在2016年至2022年期间从密歇根州的医疗补助扩大计划覆盖范围转而参加医疗保险（传统医疗保险或医疗保险优势计划）。
参与者从医疗补助扩大计划覆盖范围向医疗保险过渡经历的描述性主题。
该研究包括30名年龄在65 - 71岁之间的参与者。大多数是女性和白人，在密歇根州内具有不同的教育程度和地域代表性。19名参与者仅参加医疗保险（无双重覆盖）。确定了三个主要主题。这种保险变化是（1）不受欢迎的；（2）复杂的；（3）对于那些没有双重覆盖的人来说，经济负担沉重。
我们的研究结果表明，65岁前后的医疗补助资格标准应更好地协调一致，并且获得无偏见的医疗保险参保指导有助于促进这些计划之间的平稳过渡。
