More Older Americans Can Afford Health Care Through a Program Already Available

AARP, together with other nonprofits, is helping older Americans access critical medical services by increasing enrollment in an under-used government program. The effort addresses a crucial need. Of the many Americans who could benefit from this financial assistance, more than 1.4 million [i] may already qualify but don’t realize it or aren’t enrolling for another reason.

The Medicare Savings Programs (MSPs) help individuals with limited incomes pay Medicare premiums, co-pays, deductibles, and other out-of-pocket expenses—saving them a minimum of $165 each month in health care costs. [ii] MSPs have long remained under-enrolled with only about half of people who are eligible nationwide actually signed up. [iii] However, a recent proposed change to federal rules, and moves by some states to expand MSP eligibility have created a favorable environment for community organizations to initiate or reinvigorate enrollment efforts. Current efforts by AARP and other organizations could help to establish best practices for future enrollment work.

Drilling Down to the Source

Studies highlight a variety of reasons why people eligible for MSPs aren’t signing up. Many are unaware of the programs, while others are deterred by the cumbersome application process.

To better understand why people who are eligible for the program do not enroll, AARP Foundation launched an outreach initiative in 2020 by hosting roundtable discussions with potential enrollees. What the Foundation found is that would-be enrollees are overwhelmed by information—finding themselves inundated with mailers, phone calls and TV commercials touting various Medicare-related products. They are fearful of scams and fret that one wrong click online could make them a victim. Some also worry that enrolling in a new program could cause them to lose the coverage or choice of health care providers that they already have. They want straightforward information from trusted sources.

People are also afraid that signing up for an MSP could affect their other benefits, such as food assistance, says Stephanie McGuire, chief development officer for Columbia, South Carolina-based SC Thrive. ^[iv] The nonprofit, which is an AARP Foundation grant recipient, is a statewide community-based organization that helps connect South Carolina residents with social services and benefits. “There is still so much misinformation about what programs are out there, especially for seniors,” McGuire says.

Reaching the Hard to Reach

Previous outreach and education methods have shown there is no easy, one-size-fits-all approach to fixing MSP under-enrollment. However, groups in New York, South Carolina and elsewhere are exploring new strategies and revising old ones that potentially have broader implications. Such approaches include identifying potential enrollees via electronic health records and working with trusted community leaders to spread the word about MSPs. The results of these experiments could help identify best practices for states and community groups around the country working to enroll more people in MSPs.

SC Thrive has found that teaming with AARP to cobrand materials has been successful in helping build trust and establish relationships with individuals. In its first year as an AARP grantee, it helped more than 3,100 individuals apply for MSPs, exceeding its initial goal.  

The Foundation’s current round of funding includes seven grantees and aims to serve more than 7,000 individuals. In addition to SC Thrive, the grantees include the national nonprofit Medicare Rights Center (MRC), a hospital system in Ohio, a legal aid group in Michigan, a regional commission that coordinates area agencies on aging in Alabama, a nonprofit serving Latino and American Indian communities in New Mexico, and a benefits enrollment center serving Maryland and Pennsylvania. The groups will be testing a variety of outreach and messaging strategies. [v] The results will hopefully inform other MSP enrollment efforts around the country as states, nonprofits, health care providers and other organizations work to ensure older adults can afford the health care services they need.

Making Policy Changes Can Also Improve Access to MSPs

Policy changes are one option for improving access to MSPs. One such solution: expanding who can qualify for MSPs. Raising income limits and other steps to boost eligibility may require legislative or regulatory changes. Some states, including New York and Massachusetts, have recently undertaken such efforts.

Last year, New York lawmakers passed legislation raising MSP income limits for residents age 65 and over. AARP New York and MRC worked together to advocate for the change—educating lawmakers in Albany about the state’s MSP and the opportunity to capitalize on available federal funding to partially pay for those newly eligible. Collaborating with a nationally known organization with extensive knowledge of MSP was key, says AARP New York State Director Beth Finkel. [vi]

The state will likely incur some additional costs to cover the expanded population. However, MRC estimates that, in return, up to 300,000 New Yorkers could get help paying their medical bills. With the help of grant funding from AARP Foundation, MRC is conducting a variety of outreach and enrollment efforts. [vii] Plans include holding in-person and virtual events, training staff in organizations that work with older adults, identifying areas where there are health and racial disparities, and implementing a media messaging campaign.

Efforts to both expand who is eligible for MSPs and to test outreach and messaging strategies will hopefully inform other MSP enrollment efforts around the country as states, nonprofits, health care providers and other organizations work to ensure older adults can afford the health care services they need.


[i] In 2022, the Social Security Administration sent letters to 1.47 million Medicare beneficiaries who may be eligible for MSPs and/or the Medicare Extra Help program, which helps pay prescription drug costs. For more information about this process, see Social Security Administration, Program Operations Manual System website, accessed October 10, 2022, https://secure.ssa.gov/poms.nsf/lnx/0600815025.

[ii] This is the monthly Part B premium for 2023 announced by the Centers for Medicare & Medicaid Services, “2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts,” September 27, 2022, https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly.

[iii] Kyle J. Caswell and Timothy A. Waidmann, “Medicare Savings Program Enrollees and Eligible Non-Enrollees,” (Washington, DC: The Urban Institute, June 2017), https://www.macpac.gov/wp-content/uploads/2017/08/MSP-Enrollees-and-Eligible-Non-Enrollees.pdf

[iv] AARP Public Policy Institute interview with SC Thrive staff Chief Marketing and Training Officer Stephanie McGuire, October 10, 2022.

[v] For more information see Advancing Economic Opportunity Among Older Adults, https://www.aarp.org/aarp-foundation/grants/info-2021/advancing-effective-solutions-medicare-savings-programs-rfa.html.  

[vi] AARP Public Policy Institute interviews with AARP New York, September 29, 2022 and October 20, 2022.

[vii] AARP Public Policy Institute interview with Medicare Rights Center President Frederic Riccardi, October 7, 2022.