Medicare Savings Programs (MSPs): Eligibility and Enrollment Trends

There is a gap in our understanding about changes in eligibility and enrollment for Medicare Savings Programs (MSPs). We analyzed data from the Survey of Income and Program Participation (SIPP) linked to the Medicare Enrollment Database (EDB) and Medicaid Statistical Information System (MSIS) to study eligibility and enrollment trends in MSPs, particularly in the QMB, SLMB, and QI programs. We found that the MSP participation rate increased slowly and steadily for both age groups across all MSP groups. In our descriptive comparisons, we found MSP enrollees (relative to the MSP eligible-but-not-enrolled population) were more likely to be 18 to 64 years old, not married, male, a member of a racial group other than White, and Latinx. MSP-enrollees (relative to the MSP-eligible but not enrolled population) were also more likely to not have completed high school; to receive Supplemental Security Income (SSI) or Supplemental Nutrition Assistance Program (SNAP) benefits; to have no limitations in activities of daily living; to self-report a health status of very good, good, or fair; to not have private insurance; to use at least one prescription drug; and to be living in a state that uses the standard federal asset limits for MSP eligibility. MSP enrollees also spent more days in the hospital, had more visits to a doctor’s office, and had fewer dental visits in the past year than people who were eligible for MSPs but not enrolled. When we examined the correlation between different characteristics and MSP enrollment, controlling for all other characteristics, we found those enrolled in SSI or SNAP were more likely to be enrolled in an MSP. Specifically, SSI receipt was associated with an 8.7 percentage point increase in the likelihood of MSP enrollment, and SNAP receipt was associated with a 38.6 percentage point increase in the likelihood of MSP enrollment. We also found those who were 65 or older (-8.5 percentage points), married (-11.6 percentage points), and high school graduates (-8.9 percentage points), were less likely to be enrolled in an MSP. In our models examining the effect of MIPPA, we found no strong evidence that the implementation of MIPPA in 2010 had any meaningful impact on MSP eligibility, enrollment, or participation. In our June 8, 2023 2 of 12 cross-sectional regression models examining OOP spending, we found that MSP enrollees reported 24 percent lower total OOP spending for medical costs than their MSP-eligible-but-not-enrolled peers (p = 0.08). When we divided OOP spending into component parts, we found MSP enrollment was associated with 33 percent lower OOP spending for non-over-the-counter medical expenses (p = 0.09). Although we also found lower over-the-counter medical and premium spending among MSP enrollees, neither difference was statistically significant at the 10 percent level. We did not find any statistically significant differences for the financial well-being measures between MSP enrollees and the MSP-eligible-but-not-enrolled population after controlling for observable characteristics.