{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:38:10Z","timestamp":1792618690522,"version":"4.5.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods<\/jats:title>\n                    <jats:p>Quantitative data were collected through a community-based survey of first-time Medicare beneficiaries (N\u2009=\u200993). 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 3 focus groups and 4 individual interviews (N\u2009=\u200916) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 5 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Implications<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geront\/gnag213","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:07:03Z","timestamp":1788415623000},"source":"Crossref","is-referenced-by-count":0,"title":["Medicare enrollment literacy among first-time Black beneficiaries: Insights from a mixed-methods study"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5284-425X","authenticated-orcid":false,"given":"Wiljanda M","family":"Boatwright","sequence":"first","affiliation":[{"name":"Department of Healthcare Leadership and Management, Medical University of South Carolina , Charleston, South Carolina,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"2026102116415867700_gnag213-B1","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1257\/aer.101.4.1180","article-title":"Choice inconsistencies among the elderly: Evidence from plan choice in the Medicare Part D program","volume":"101","author":"Abaluck","year":"2011","journal-title":"The American Economic Review"},{"key":"2026102116415867700_gnag213-B2","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: An updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Annals of Internal Medicine"},{"key":"2026102116415867700_gnag213-B3","doi-asserted-by":"publisher","first-page":"27","DOI":"10.3316\/QRJ0902027","article-title":"Document analysis as a qualitative research method","volume":"9","author":"Bowen","year":"2009","journal-title":"Qualitative Research Journal"},{"key":"2026102116415867700_gnag213-B4","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"key":"2026102116415867700_gnag213-B5","author":"Centers for Medicare & Medicaid Services","year":"2023"},{"key":"2026102116415867700_gnag213-B6","author":"Centers for Medicare & Medicaid Services","year":"2024"},{"key":"2026102116415867700_gnag213-B7","author":"Centers for Medicare & Medicaid Services Office of Minority Health","year":"2022"},{"key":"2026102116415867700_gnag213-B8","doi-asserted-by":"publisher","first-page":"e93","DOI":"10.2196\/jmir.2645","article-title":"The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer\/Internet use","volume":"15","author":"Choi","year":"2013","journal-title":"Journal of Medical Internet Research"},{"key":"2026102116415867700_gnag213-B9","doi-asserted-by":"publisher","first-page":"gnag092","DOI":"10.1093\/geront\/gnag092","article-title":"From access to agency: Empowering older adults for critical AI use","volume":"66","author":"Choi","year":"2026","journal-title":"The Gerontologist"},{"key":"2026102116415867700_gnag213-B10","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs: Principles and practices","volume":"48","author":"Fetters","year":"2013","journal-title":"Health Services Research"},{"key":"2026102116415867700_gnag213-B11","volume-title":"Medicare Advantage 2023 spotlight: First look","author":"Freed","year":"2022"},{"key":"2026102116415867700_gnag213-B12","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1111\/j.1475-6773.2011.01276.x","article-title":"How much choice is too much? The case of the Medicare prescription drug benefit","volume":"46","author":"Hanoch","year":"2011","journal-title":"Health Services Research"},{"key":"2026102116415867700_gnag213-B13","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"Journal of Biomedical Informatics"},{"key":"2026102116415867700_gnag213-B14","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1377\/hlthaff.2011.1168","article-title":"An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care","volume":"31","author":"Hibbard","year":"2012","journal-title":"Health Affairs (Project Hope)"},{"key":"2026102116415867700_gnag213-B16","doi-asserted-by":"publisher","first-page":"gnae062","DOI":"10.1093\/geront\/gnae062","article-title":"Are virtual assistants trustworthy for Medicare information: An examination of accuracy and reliability","volume":"64","author":"Langston","year":"2024","journal-title":"The Gerontologist"},{"key":"2026102116415867700_gnag213-B17","volume-title":"Traditional Medicare or Medicare Advantage: How older Americans choose and why","author":"Leonard","year":"2022"},{"key":"2026102116415867700_gnag213-B18","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1377\/hlthaff.2011.0132","article-title":"Complex Medicare Advantage choices may overwhelm seniors\u2014Especially those with impaired decision making","volume":"30","author":"McWilliams","year":"2011","journal-title":"Health Affairs (Project Hope)"},{"key":"2026102116415867700_gnag213-B19","doi-asserted-by":"publisher","first-page":"gnae110","DOI":"10.1093\/geront\/gnae110","article-title":"Developing a framework for digital activities of daily living","volume":"64","author":"Mois","year":"2024","journal-title":"The Gerontologist"},{"key":"2026102116415867700_gnag213-B20","doi-asserted-by":"publisher","first-page":"2163","DOI":"10.1056\/NEJMhpr1804089","article-title":"Medicare Advantage checkup","volume":"379","author":"Neuman","year":"2018","journal-title":"New England Journal of Medicine"},{"key":"2026102116415867700_gnag213-B21","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1080\/10810730.2014.936568","article-title":"Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and measuring consumer ability to choose and use private health insurance","volume":"19 Suppl 2","author":"Paez","year":"2014","journal-title":"Journal of Health Communication"}],"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article-pdf\/doi\/10.1093\/geront\/gnag213\/70934956\/gnag213.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/66\/11\/gnag213\/70934956\/gnag213.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/66\/11\/gnag213\/70934956\/gnag213.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:42:03Z","timestamp":1792615323000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/article\/doi\/10.1093\/geront\/gnag213\/8780874"}},"subtitle":[],"editor":[{"given":"Jennifer","family":"Baumbusch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":20,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,10,8]]}},"URL":"https:\/\/doi.org\/10.1093\/geront\/gnag213","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,9,2]]},"article-number":"gnag213"}}