{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:30:05Z","timestamp":1785774605880,"version":"3.56.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objectives<\/jats:title>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.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Eligibility for the MSPs.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>The primary sample included 26\u202f240 respondent-year observations, representing 179\u202f221\u202f355 beneficiary-years (14.0% [95% CI, 13.4%-14.5%] of respondents were &amp;lt;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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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\u2014although still with low income and eligible for the MSPs\u2014individuals may be more likely to be associated with gains in the MSP take-up.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.35408","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T15:30:44Z","timestamp":1759505444000},"page":"e2535408","source":"Crossref","is-referenced-by-count":5,"title":["Medicare Savings Program Take-Up Estimates and Profile of Enrolled and Unenrolled Individuals"],"prefix":"10.1001","volume":"8","author":[{"given":"Sarah","family":"Kotb","sequence":"first","affiliation":[{"name":"Economics Department, College of Social and Behavioral Science, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna D.","family":"Sinaiko","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"issue":"4","key":"zoi250992r8","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1377\/hlthaff.2020.02272","article-title":"Medicaid coverage \u201ccliff\u201d increases expenses and decreases care for near-poor Medicare beneficiaries.","volume":"40","author":"Roberts","year":"2021","journal-title":"Health Aff (Millwood)"},{"issue":"3","key":"zoi250992r15","first-page":"13","article-title":"Eligibility for the Medicare buy-in programs, based on a survey of income and program participation simulation.","volume":"63","author":"Rupp","year":"2000","journal-title":"Soc Secur Bull"},{"issue":"2","key":"zoi250992r17","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1111\/1475-6773.12349","article-title":"Reforming access: trends in Medicaid enrollment for new Medicare beneficiaries, 2008-2011.","volume":"51","author":"Keohane","year":"2016","journal-title":"Health Serv Res"},{"issue":"3","key":"zoi250992r19","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1001\/jama.2024.21078","article-title":"Increasing Medicare Savings Program enrollment\u2014improving affordability of care.","volume":"333","author":"Patel","year":"2025","journal-title":"JAMA"},{"issue":"3","key":"zoi250992r23","first-page":"76","article-title":"Comparing beneficiaries of the Medicare savings programs with eligible nonparticipants.","volume":"64","author":"Sears","year":"2001","journal-title":"Soc Secur Bull"},{"issue":"37","key":"zoi250992r27","doi-asserted-by":"publisher","first-page":"5714","DOI":"10.1080\/00036846.2024.2365458","article-title":"\u201cLesser-of\u201d payment policies and the use of physicians\u2019 services among dual-eligible beneficiaries in the United States.","volume":"57","author":"Hayford","year":"2025","journal-title":"Appl Econ"},{"issue":"11","key":"zoi250992r28","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1001\/jamainternmed.2020.2783","article-title":"Cognition and take-up of the Medicare Savings Programs.","volume":"180","author":"Roberts","year":"2020","journal-title":"JAMA Intern Med"},{"key":"zoi250992r31","doi-asserted-by":"publisher","author":"Bearson","journal-title":"Behavioural Public Policy","DOI":"10.1017\/bpp.2023.21"},{"issue":"5","key":"zoi250992r38","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/1475-6773.13545","article-title":"New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.","volume":"55","author":"Roberts","year":"2020","journal-title":"Health Serv Res"},{"key":"zoi250992r1","unstructured":"2024 Medicare Parts A & B premiums and deductibles. 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Beneficiary experience, affordability, utilization, and quality in Medicare Advantage and traditional Medicare: a review of the literature. KFF. September 16, 2022. Accessed March 2, 2025. https:\/\/www.kff.org\/report-section\/beneficiary-experience-affordability-utilization-and-quality-in-medicare-advantage-and-traditional-medicare-a-review-of-the-literature-report\/"},{"key":"zoi250992r12","unstructured":"Leonard? F, Jacobson? G, Haynes? LA, Collins? SR. Traditional Medicare or Medicare Advantage: how older Americans choose and why. Commonwealth Fund. October 17, 2022. Accessed August 13, 2025. https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2022\/oct\/traditional-medicare-or-advantage-how-older-americans-choose"},{"key":"zoi250992r13","unstructured":"Moon? M, Kuntz? C, Pounder? L. Protecting low income Medicare beneficiaries. Urban Institute. December 1996. 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