Health Reform WK-EDGE Lowering the enrollment age for Medicare could affect Medicaid enrollees
Friday, June 18, 2021

Lowering the enrollment age for Medicare could affect Medicaid enrollees

By Deborah Hammonds, J.D.

Individuals eligible for both Medicare and Medicaid could be impacted by proposals to lower Medicare enrollment age.

Proposals from President Biden and House Democrats to lower the enrollment age for Medicare has raised questions on how such a change would work or be financially supported, the proposals have also raised questions on how such a change might affect Medicaid enrollees, according to the Kaiser Family Foundation (KFF). The President’s FY 2022 budget proposes lowering the Medicare enrollment age from 65 to 60 while a group of House Democrats have called for the President’s American Families Plan to include a provision lowering the Medicare age to 60 or 55. Lowering the Medicare eligibility age based solely on work history to 60 could provide coverage to older adults who are currently uninsured or provide a more affordable option for people with private health insurance coverage. Lowering the Medicare eligibility age could also affect Medicaid enrollees in this age range with some possibly losing Medicaid coverage when they gain Medicare and others possibly becoming dually eligible for both programs, depending on the details of how it would work.

KFF reviewed the current policy and assessed what changes could affect enrollees should the age for Medicare enrollment be lowered, including how the various pathways available to determine eligibility for Medicaid may change; whether individuals in the new age range could retain Medicaid if eligible or instead would move from Medicaid to Medicare; and how lowering the Medicare age might affect state and federal costs and provider payments.

Lowering the Medicare enrollment age could have considerable impact on the scope of covered benefits, out-of-pocket costs, and provider access for low-income people as well as implications for state and federal health care costs. Depending on individual circumstances and key policy decisions, people who move from Medicaid to Medicare might experience higher out-of-pocket costs and/or fewer covered benefits. However, enrollees might have access to a broader provider network in traditional Medicare, compared to their state’s Medicaid program. KFF concluded that on the whole, current Medicaid enrollees are likely to face different issues than those who move from private insurance or uninsured status to Medicare.

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