Medicare Savings Program Take-Up Estimates and Profile of Enrolled and Unenrolled Individuals

Medicare enrollees with low income report challenges affording out-of-pocket costs for health care. Although the Medicare Savings Programs (MSPs) were established to provide financial support, recent patterns in program take-up are understudied.

To provide national and state-level estimates of take-up of the MSPs from 2018 to 2020 and describe the profile of enrolled and unenrolled individuals eligible for the MSPs.

This cross-sectional analysis used data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of community-dwelling Medicare beneficiaries. Respondents from 2018 to 2020 who completed the income and assets questionnaire, which allowed assessment of MSP eligibility, were analyzed. Data were analyzed in July 2024.

Eligibility for the MSPs.

The take-up rate of the MSPs, defined as the proportion of eligible beneficiaries enrolled in the program. The MCBS survey weights were applied to create a subsample that was nationally representative of the community-dwelling Medicare population.

The primary sample included 26 240 respondent-year observations, representing 179 221 355 beneficiary-years (14.0% [95% CI, 13.4%-14.5%] of respondents were <65 years, 55.1% [95% CI, 54.1%-56.0%] were female, and 37.7% [95% CI, 36.0%-39.4%] had a high school education or lower). A total of 20.9% (95% CI, 19.8%-22.0%) of the primary sample was eligible for the MSPs. Of those eligible, 56.7% (95% CI, 54.5%-59.0%) were enrolled. Take-up rates varied widely across states, ranging from 41.5% (95% CI, 25.7%-57.3%) in Ohio to 72.9% (95% CI, 67.6%-78.2%) in California. Take-up among Medicare Advantage beneficiaries was higher than among those in traditional Medicare (61.3% vs 52.9%; difference, 8.4 percentage points [pp] [95% CI, 3.5-13.2 pp]). Compared with eligible beneficiaries who were not enrolled, enrolled individuals had greater economic insecurity, including being 30.0 pp (95% CI, 25.4-34.6 pp) more likely to report income below 100% of the federal poverty level and 16.4 pp (95% CI, 13.2-19.6 pp) more likely to report assets less than $3000.

This cross-sectional study of Medicare beneficiaries suggests that MSP take-up remains incomplete and varied across states despite policy efforts. A policy to encourage participation in the MSPs among eligible populations that target less socially and financially vulnerable-although still with low income and eligible for the MSPs-individuals may be more likely to be associated with gains in the MSP take-up.