Background Health insurance literacy is crucial for making informed decisions about insurance plans, particularly in the context of the complex structure of Medicare Advantage (MA). Longer MA enrollment has the potential to improve health insurance literacy, which may, in turn, enhance access to and affordability of care. However, the extent of this relationship remains poorly understood. Objective To examine the association of the duration of MA enrollment with health insurance literacy as well as access to and affordability of care. Design Cross-sectional study within the MA setting. Participants 13,103 Medicare Advantage enrollees from the 2017-2020 Medicare Current Beneficiary Survey. Main Measures Health insurance literacy, access to care, and affordability of care. Key Results Compared to those enrolled in MA for 1-2 years, those with 3-5, 6-10, and ≥11 years of enrollment were more likely to report better understanding and knowledge of Medicare (adjusted differences ranging from 3.44 [p=0.011] to 6.53 [p<0.001] percentage points). Additionally, they were less likely to report trouble getting needed care (1.85 [p=0.007], 2.68 [p < 0.001], 2.08 [p=0.01] percentage points for 3-5, 6-10, and ≥11 years of enrollment). More pronounced differences were observed in care affordability: delaying care due to cost decreased by -1.36 (p=0.13), 2.59 (p=0.003), 2.39 (p=0.04) percentage points while having problems paying medical bills decreased by 3.48 (p<0.001), 2.76 (p<0.001), 2.93 (p=0.003) percentage points. However, these associations did not necessarily increase with enrollment beyond 3–5 years. Conclusions Our findings indicate that longer MA enrollment is associated with higher health insurance literacy and better access to and affordability of care. However, this association appears to plateau after the first few years of enrollment. These results underscore the importance of implementing targeted programs to enhance health insurance literacy among those newly enrolled in MA, with the goal of improving access to and affordability of care. Graphical Abstract

Associations of Medicare Advantage Enrollment Duration with Health Insurance Literacy and Access to and Affordability of Health Care

期刊论文
发表日期：

2025年5月21日

查看全文

Elizabeth Staton,
Sungchul Park

摘要

Background

Health insurance literacy is crucial for making informed decisions about insurance plans, particularly in the context of the complex structure of Medicare Advantage (MA). Longer MA enrollment has the potential to improve health insurance literacy, which may, in turn, enhance access to and affordability of care. However, the extent of this relationship remains poorly understood.

Objective

To examine the association of the duration of MA enrollment with health insurance literacy as well as access to and affordability of care.

Design

Cross-sectional study within the MA setting.

Participants

13,103 Medicare Advantage enrollees from the 2017-2020 Medicare Current Beneficiary Survey.

Main Measures

Health insurance literacy, access to care, and affordability of care.

Key Results

Compared to those enrolled in MA for 1-2 years, those with 3-5, 6-10, and ≥11 years of enrollment were more likely to report better understanding and knowledge of Medicare (adjusted differences ranging from 3.44 [p=0.011] to 6.53 [p<0.001] percentage points). Additionally, they were less likely to report trouble getting needed care (1.85 [p=0.007], 2.68 [p < 0.001], 2.08 [p=0.01] percentage points for 3-5, 6-10, and ≥11 years of enrollment). More pronounced differences were observed in care affordability: delaying care due to cost decreased by -1.36 (p=0.13), 2.59 (p=0.003), 2.39 (p=0.04) percentage points while having problems paying medical bills decreased by 3.48 (p<0.001), 2.76 (p<0.001), 2.93 (p=0.003) percentage points. However, these associations did not necessarily increase with enrollment beyond 3–5 years.

Conclusions

Our findings indicate that longer MA enrollment is associated with higher health insurance literacy and better access to and affordability of care. However, this association appears to plateau after the first few years of enrollment. These results underscore the importance of implementing targeted programs to enhance health insurance literacy among those newly enrolled in MA, with the goal of improving access to and affordability of care.

Graphical Abstract