New Issue Brief: Rising MSP Participation Signals Progress, but Significant Enrollment Gaps Remain

Policy Analysis and DevelopmentEligibility and Enrollment

May 26

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Medicare Savings Programs (MSPs) help eligible low-income older adults afford health care by covering Medicare premiums and cost-sharing that might otherwise impede access to services. Despite the value MSPs provide, many eligible individuals are not enrolled, limiting access to care and financial stability for many beneficiaries.

To provide updated insights on how many beneficiaries are eligible for but not enrolled in MSPs, West Health Policy Center (West Health) recently partnered with Aurrera Health Group and the Urban Institute to examine MSP participation nationwide. A new issue brief Rising MSP Participation Signals Progress, but Significant Enrollment Gaps Remain, summarizes findings from Urban Institute's recent analysis, Medicaid Participation Among Medicare Savings Program Eligibles, and identifies opportunities for policymakers to strengthen enrollment among those eligible for MSPs. This analysis builds upon previous work from West Health and Aurrera Health Group outlining state policy and administrative strategies to expand MSP eligibility and participation.

The new analysis suggests meaningful progress over the past decade, with participation in each major MSP type exceeding 55 percent among eligible individuals from 2021 to 2023 — well above earlier estimates from 2009 to 2010. While these gains are encouraging, more than one in three eligible individuals remain unenrolled, underscoring the continued need for state and federal action to close persistent enrollment gaps.

Findings also point to several factors associated with participation rates. Individuals enrolled in other means-tested programs, such as Supplemental Security Income (SSI) and SNAP, were more likely to participate in MSPs, suggesting that aligning and automating enrollment processes across programs may reduce barriers. Conversely, participation was lower among adults age 65 and older, signaling a need for more targeted outreach and engagement for this demographic.

As policymakers continue working to improve affordability and access to care for Medicare beneficiaries, these findings provide timely evidence and practical recommendations to help strengthen MSP participation. For more information on how we can help your organization strengthen access to Medicare Savings Programs, please contact Kristal Vardaman.