Recent Analysis Helps Clarify Progress and Gaps in Medicare Savings Program Participation

Policy Analysis and DevelopmentEligibility and Enrollment

Jul 30

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Medicare Savings Programs (MSPs) are an important affordability tool for older adults and people with disabilities who have limited resources. By helping eligible Medicare beneficiaries pay for premiums and, in some cases, cost-sharing, MSPs can reduce out-of-pocket costs that may otherwise make it harder for people to access care or manage other basic expenses. Yet despite the value of these programs, participation has historically lagged, leaving many eligible individuals without assistance.

West Health Policy Center (West Health) recently partnered with Aurrera Health Group and the Urban Institute (Urban) to examine MSP participation nationwide. The issue brief Rising MSP Participation Signals Progress, but Significant Enrollment Gaps Remain summarizes findings from Urban’s analysis, Medicaid Participation Among Medicare Savings Program Eligibles. Urban found that estimated participation in each MSP type exceeded 55 percent from 2021 to 2023, which was considerably higher than their earlier estimates from 2009–2010. At the same time, across all MSP types, more than one in three eligible individuals were still not enrolled.

The brief also looks beyond the overall participation rate to better understand demographics of eligible individuals who are and are not enrolling in MSPs. Among the key findings:

MSP participation was higher among individuals enrolled in other means-tested programs, such as Supplemental Security Income or the Supplemental Nutrition Assistance Program.
MSP participation was lower among adults age 65 and older compared with younger Medicare beneficiaries.
Individuals living in states with more generous MSP asset limits were more likely to enroll.
Participation was lower among individuals at the upper end of eligibility thresholds, people with more education, and those with private health insurance.

Together, these findings suggest that MSP participation is shaped not only by eligibility, but also by program awareness, administrative burden, state policy choices, and how different populations connect to public benefit systems. The issue brief offers considerations for policymakers seeking to support more robust MSP participation, building upon previous work from West Health and Aurrera Health Group outlining state policy and administrative strategies to expand MSP eligibility and participation. It also comes as MSPs are receiving renewed interest among Medicare affordability experts, including the Aging & Disability Health Policy Lab’s recent release of model policies to promote MSP access.

For more information on how Aurrera Health can help your organization strengthen access to MSPs, please contact Kristal Vardaman.