Entering Medicare from High Deductible Health Plans: Changes in affordability and care for individuals with chronic conditions - PROJECT SUMMARY/ABSTRACT
Over 40% of Americans with employer-sponsored insurance are enrolled in high deductible health plans
(HDHPs), which require enrollees to pay their full medical and prescription drug costs until their deductible is
reached. Average deductibles in HDHPs are approaching $2,500, raising concerns that older adults with
chronic conditions may face substantial financial burdens or defer care in HDHPs. However, there is little
evidence on the dynamics of HDHP enrollment and its link to cost-related barriers among adults ages 60-64,
who are nearing Medicare eligibility at age 65. In contrast, deductibles for outpatient care are low for Medicare
beneficiaries, and even lower for those enrolled in Medicare Advantage (MA) plans, an increasingly attractive
option for individuals entering Medicare. The distinct difference in out-of-pocket costs between HDHPs and
Medicare has led some policymakers to propose expanding Medicare coverage for older adults. Little is known
about how this difference in benefit design between HDHPs and Medicare affects older adults’ use of care or
out-of-pocket costs. This research proposal will fill these gaps in evidence by studying HDHP enrollment trends
among adults 60-64 and transitions in coverage from employer-sponsored HDHPs to MA when individuals turn
65. We will use quasi-experimental methods to understand characteristics of older HDHP enrollees who
experience financial barriers to care and evaluate changes in costs, health care utilization, and chronic
condition management for individuals entering MA from HDHPs relative to other employer sponsored plans
with lower deductibles. Aim 1 will use the Medical Expenditure Panel Survey to study HDHP enrollment trends
among adults ages 60-64, identifying subgroups for whom HDHPs exacerbate barriers to care. Aim 2a will use
longitudinal claims from a large national insurer to compare short- and long-term changes in out-of-pocket
spending and utilization upon entering MA from an HDHP vs. other commercial insurance plans. Aim 2b will
employ a similar study design in a subset of individuals with prevalent chronic conditions (e.g., diabetes,
hypertension, and hyperlipidemia) and examine changes in chronic condition management and related health
outcomes. This work focuses on populations and programs of interest to AHRQ and policymakers by
evaluating how insurance coverage changes affect cost, access, utilization, and health outcomes in AHRQ
priority populations, including older adults and individuals with special care needs related to chronic disease.
This work will be the first study to investigate how coverage transitions HDHPs to MA, which are becoming
increasingly common, affect out-of-pocket costs, use of care, and health for older adults. Thus, these findings
will provide timely evidence about how proposed expansions of Medicare could affect financial and health
outcomes for aging adults currently enrolled in employer-sponsored health plans with high deductibles.
