Entering Medicare from High Deductible Health Plans: Changes in affordability and care for individuals with chronic conditions

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Abstract

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.