Keywords

Medicare; Disparities; Public Health; Older Adults

Abstract

The Dual-Eligible and Part D Low-Income Subsidy programs help low-income Medicare beneficiaries cover healthcare and prescription costs. However, information on the sociodemographic characteristics of eligible Medicare beneficiaries for both programs is limited. The 2017-2023 Medicare Current Beneficiary Survey Public Use Files, a nationally representative dataset of Medicare beneficiaries aged ≥65 years (Ns: ranged from 10,186-11,278), were used for this repeated cross-sectional study. A three-level categorical dependent variable for each year was created: (1) has Dual-Eligible and Part D Low-Income Subsidy, (2) has either program, or (3) has neither (reference group). Survey-weighted multinomial regression models were used to examine relationships between socio-demographics and the dependent variable, adjusted for health conditions. During survey years, the proportions of beneficiaries enrolled in both programs ranged from 10.6%-12.7%; in either program, from 1.9%-2.7%; and in neither program, from 85.4%-86.7%. In the adjusted analyses, minority beneficiaries were more likely than non-Hispanic Whites to enroll in both programs (e.g., non-Hispanic Blacks, OR ranged from 2.24-3.41, all p< 0.05). Beneficiaries with less than a high school education (HSE) were more likely to enroll in both programs (OR ranged from 2.14-3.08, all p< 0.05) or in either program (OR ranged from 1.80-2.99, all p< 0.05, except 2019) than those with > a HSE. Beneficiaries with ADL limitations were more likely to enroll in both programs than those without limitations (e.g., 1-2 ADL limitations, OR ranged from 1.34-1.89, all p< 0.05, except 2020). About 10.6%-12.7% (representing ~5.2- 6.9 million) of beneficiaries were enrolled in both programs; this group was mainly from lower socio-demographic and poorer health status groups. These findings indicate that changes to both programs may affect many vulnerable older adults. Additionally, we found that many beneficiaries—representing ~1.3 to 1.7 million people—were likely eligible for both programs but were not enrolled, highlighting the need for targeted efforts to streamline enrollment.

Thesis Completion Year

2026

Thesis Completion Semester

Spring

Thesis Chair

Ng, Boon Peng

College

College of Nursing

Department

Nursing Systems

Thesis Discipline

Nursing

Language

English

Access Status

Campus Access

Length of Campus Access

5 years

Campus Location

Orlando (Main) Campus

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