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. 2025 Sep 2.
doi: 10.1007/s11606-025-09789-9. Online ahead of print.

Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study

Susan L Hayes  1 , Mary E Byrnes  2 , Wendy Furst  3 , Erin Beathard  4 , Renuka Tipirneni  5   6
Affiliations

Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study

Susan L Hayes et al. J Gen Intern Med. .

Abstract

Background: The Affordable Care Act expanded Medicaid eligibility for low-income adults who are not Medicare eligible while leaving in place states' more restrictive dual eligibility criteria. When Medicaid expansion enrollees turn 65 and transition to Medicare as their primary insurer, they may lose Medicaid and face higher premiums and out-of-pocket costs, yet there is little understanding of how older adults navigate this change in insurance programs.

Objective: To investigate the experiences of Medicaid expansion enrollees who transitioned to Medicare coverage at age 65.

Design: This is an interpretive descriptive qualitative study. Primary data were collected through semi-structured in-depth interviews conducted from April 2022 to February 2023. Data were analyzed in an iterative process, informed by interpretive description, a non-categorical qualitative methodology initially developed to address problems in applied settings.

Participants: Participants had to be at least 65 years old, reside in Michigan, and have transitioned from Michigan's Medicaid expansion coverage to Medicare (either traditional or Medicare Advantage) between 2016 and 2022.

Main outcomes and measures: Descriptive themes of participant experiences navigating the transition from Medicaid expansion coverage to Medicare.

Key results: The study included 30 participants aged 65-71. A majority were women and White, with diverse educational attainment and geographic representation within Michigan. Nineteen participants were Medicare-only (without dual coverage). Three main themes were identified. This change in insurance was (1) unwanted; (2) complicated; and (3) for those without dual coverage, financially burdensome.

Discussion: Our findings suggest a better alignment of Medicaid eligibility criteria before and after age 65, and access to unbiased Medicare enrollment guidance could help facilitate a smoother transition between these programs.

Keywords: affordable care act; health insurance transitions; low income.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: The study was deemed exempt from review by the University of Michigan Institutional Review Board and by the Brown University Human Subject Protection Program and followed the Standards for Reporting Qualitative Research (SRQR) reporting guideline. Participants provided consent to participate prior to their interviews. Conflict of Interest: The authors declare that they do not have a conflict of interest.

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References

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