Entering Medicare from High Deductible Health Plans: Changes in affordability and care for individuals with chronic conditions

项目摘要/摘要 超过40%的拥有雇主赞助保险的美国人参加了高免赔额健康计划 (HDHP)，该计划要求参保人支付全部医疗和处方药费用，直到他们的免赔额达到 已到达。HDHP的平均免赔额接近2500美元，这引发了人们对老年人患有 慢性疾病可能面临巨大的经济负担或推迟人类发展计划的护理。然而，几乎没有 关于60-64岁成年人参加人类发展计划的动态及其与费用相关障碍的联系的证据， 这些人在65岁时接近联邦医疗保险的资格。相比之下，医疗保险的门诊免赔额较低 受益人，对于那些参加联邦医疗保险优势(MA)计划的人来说，甚至更低，越来越有吸引力 进入联邦医疗保险的个人的选项。HDHP和HDHP在自付成本方面的显著差异 联邦医疗保险导致一些政策制定者提议扩大老年人的医疗保险覆盖范围。鲜为人知 关于HDHPS和Medicare之间的福利设计差异如何影响老年人对医疗保健或 自付费用。这项研究提案将通过研究HDHP注册趋势来填补这些证据上的空白 在成年人中，60岁-和个人年满60岁时从雇主赞助的高风险医疗保险向医疗保险的过渡 65.我们将使用准实验方法来了解老年HDHP参与者的特征 体验医疗方面的财务障碍并评估成本、医疗保健利用率和慢性疾病方面的变化 与雇主赞助的其他计划相比，从人类健康保险计划进入MA的个人的条件管理 免赔额较低。AIM 1将使用医疗支出小组调查来研究HDHP的注册趋势 在60岁的成年人中-，确定HDHP加剧护理障碍的亚群。Aim 2a将使用 一家大型国家保险公司的纵向索赔，以比较自付的短期和长期变化 与其他商业保险计划相比，从HDHP进入MA时的支出和使用情况。目标2b将 在具有普遍慢性病(例如，糖尿病， 高血压和高脂血症)，并检查慢性状况管理和相关健康的变化 结果。这项工作的重点是AHRQ和政策制定者感兴趣的人口和项目 在AHRQ中评估保险覆盖范围变化如何影响成本、可获得性、利用率和健康结果 优先人群，包括老年人和与慢性病有关的有特殊护理需要的个人。 这项工作将是第一项调查覆盖范围如何从HDHP过渡到MA的研究，这将成为 越来越普遍，影响自付费用、护理使用和老年人的健康。因此，这些发现 将提供及时的证据，说明拟议的医疗保险扩大可能如何影响财务和健康 目前参加雇主赞助的健康计划的老年成年人的结果，免赔额很高。

PROJECT SUMMARY/ABSTRACT Over 40% of Americans with employer-sponsored insurance are enrolled in high deductible health plans (HDHPs), which require enrollees to pay their full medical and prescription drug costs until their deductible is reached. Average deductibles in HDHPs are approaching $2,500, raising concerns that older adults with chronic conditions may face substantial financial burdens or defer care in HDHPs. However, there is little evidence on the dynamics of HDHP enrollment and its link to cost-related barriers among adults ages 60-64, who are nearing Medicare eligibility at age 65. In contrast, deductibles for outpatient care are low for Medicare beneficiaries, and even lower for those enrolled in Medicare Advantage (MA) plans, an increasingly attractive option for individuals entering Medicare. The distinct difference in out-of-pocket costs between HDHPs and Medicare has led some policymakers to propose expanding Medicare coverage for older adults. Little is known about how this difference in benefit design between HDHPs and Medicare affects older adults’ use of care or out-of-pocket costs. This research proposal will fill these gaps in evidence by studying HDHP enrollment trends among adults 60-64 and transitions in coverage from employer-sponsored HDHPs to MA when individuals turn 65. We will use quasi-experimental methods to understand characteristics of older HDHP enrollees who experience financial barriers to care and evaluate changes in costs, health care utilization, and chronic condition management for individuals entering MA from HDHPs relative to other employer sponsored plans with lower deductibles. Aim 1 will use the Medical Expenditure Panel Survey to study HDHP enrollment trends among adults ages 60-64, identifying subgroups for whom HDHPs exacerbate barriers to care. Aim 2a will use longitudinal claims from a large national insurer to compare short- and long-term changes in out-of-pocket spending and utilization upon entering MA from an HDHP vs. other commercial insurance plans. Aim 2b will employ a similar study design in a subset of individuals with prevalent chronic conditions (e.g., diabetes, hypertension, and hyperlipidemia) and examine changes in chronic condition management and related health outcomes. This work focuses on populations and programs of interest to AHRQ and policymakers by evaluating how insurance coverage changes affect cost, access, utilization, and health outcomes in AHRQ priority populations, including older adults and individuals with special care needs related to chronic disease. This work will be the first study to investigate how coverage transitions HDHPs to MA, which are becoming increasingly common, affect out-of-pocket costs, use of care, and health for older adults. Thus, these findings will provide timely evidence about how proposed expansions of Medicare could affect financial and health outcomes for aging adults currently enrolled in employer-sponsored health plans with high deductibles.