{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:53:04Z","timestamp":1786981984897,"version":"build-2736575974"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K08AG056591"],"award-info":[{"award-number":["K08AG056591"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1R36HS029143-0"],"award-info":[{"award-number":["1R36HS029143-0"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Affordable Care Act expanded Medicaid eligibility for low-income adults who are not Medicare eligible while leaving in place states\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the experiences of Medicaid expansion enrollees who transitioned to Medicare coverage at age 65.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants had to be at least 65\u00a0years old, reside in Michigan, and have transitioned from Michigan\u2019s Medicaid expansion coverage to Medicare (either traditional or Medicare Advantage) between 2016 and 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Descriptive themes of participant experiences navigating the transition from Medicaid expansion coverage to Medicare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>The study included 30 participants aged 65\u201371. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-025-09789-9","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T17:13:44Z","timestamp":1756833224000},"page":"1241-1249","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7332-0414","authenticated-orcid":false,"given":"Susan L.","family":"Hayes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Byrnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Furst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Beathard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renuka","family":"Tipirneni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"issue":"10","key":"9789_CR1","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1056\/NEJMsa1612890","volume":"376","author":"S Miller","year":"2017","unstructured":"Miller S, Wherry LR. Health and access to care during the first 2 years of the ACA Medicaid expansions. N Engl J Med. 2017;376(10):947-56. https:\/\/doi.org\/10.1056\/NEJMsa1612890","journal-title":"N Engl J Med."},{"key":"9789_CR2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jpubeco.2018.04.009","volume":"163","author":"L Hu","year":"2018","unstructured":"Hu L, Kaestner R, Mazumder B, Miller S, Wong A. The effect of the Affordable Care Act Medicaid expansions on financial wellbeing. J Public Econ. 2018;163:99-112. https:\/\/doi.org\/10.1016\/j.jpubeco.2018.04.009","journal-title":"J Public Econ."},{"issue":"6","key":"9789_CR3","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1377\/hlthaff.2017.0293","volume":"36","author":"BD Sommers","year":"2017","unstructured":"Sommers BD, Maylone B, Blendon RJ, Orav EJ, Epstein AM. Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults. 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Participants provided consent to participate prior to their interviews.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}},{"value":"The authors declare that they do not have a conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}