Non-Medicare Enrollees Aged 65 or Older: The Effects of Labor-Force Participation, Citizenship, and Age

This study investigated the relationships among age, labor force participation, and citizenship status in relation to non-Medicare enrollment among individuals aged 65 years or older. Two-level multilevel modeling (states > individuals) with a nationally representative sample of 566,003 individuals was conducted to control for state-level variations in non-Medicare enrollment rates. Among those aged 65 to 66 years, 11.2% were non-Medicare enrollees nationwide. However, analyses indicated significant differences in non-Medicare enrollment rates by age, labor force participation, citizenship status, and state of residence. Moreover, the relationship between labor force participation and age was different between U.S. citizens and noncitizens (i.e., a significant three-way interaction). Specifically, labor force participation was associated with greater probabilities of non-Medicare enrollment among U.S. citizens aged between 65 and 69 years, although the opposite was true among noncitizens. While reasons for non-Medicare enrollment appear voluntary for some older adults (i.e., employment), some associated factors indicate subpopulations of vulnerable non-Medicare enrollees (i.e., noncitizens, aged 70+).