Medicare Enrollment Literacy Among First-Time Black Beneficiaries: Insights From a Mixed-Methods Study

Limited Medicare literacy contributes to suboptimal plan selection and disparities in coverage outcomes among older adults, particularly in historically underserved communities. This study examined Medicare enrollment literacy, information access, and decision-making experiences among first-time Black Medicare beneficiaries in Southeast Queens, New York, using a convergent mixed-methods design.

Quantitative data were collected through a community-based survey of first-time Medicare beneficiaries (N = 93). Descriptive statistics assessed Medicare literacy across a 15-item scale and examined information sources, decision support, and plan selection patterns. Qualitative data were obtained through three focus groups and four individual interviews (N = 16) with community navigators and Medicare enrollment professionals and were analyzed using thematic analysis. Document analysis examined the clarity, readability, and cultural relevance of commonly used Medicare materials.

More than half of participants demonstrated low Medicare literacy, and fewer than half reported confidence in comparing plans, understanding coverage differences, and estimating out-of-pocket costs. Most participants received assistance with enrollment decisions. Qualitative findings identified five themes: complexity and information overload, reliance on informal support networks, digital navigation barriers, confusion about coverage and costs, and the importance of trust and culturally relevant communication. Document analysis indicated that many materials were complex and relied heavily on insurance terminology, with limited cultural tailoring.

Limited Medicare literacy reflects both individual knowledge gaps and systemic barriers. Enhancing culturally responsive outreach, simplifying materials, and expanding community-based decision support may improve equitable enrollment outcomes.