John Z. Ayanian is the principal investigator on this project. Debby Collins is the project contact: 617-432-3467.

Uninsured near-elderly adults are at increased risk for poor health outcomes. In particular, those with chronic conditions may enter the Medicare program at age 65 with greater morbidity and require more intensive and costly care than they would if they had been previously insured. The effects of gaining Medicare coverage on the health and health care for this vulnerable population, however, are not well defined. This project includes a series of observational studies using longitudinal data to assess comprehensively the impact of Medicare coverage on the health and health care of previously uninsured adults and other disadvantaged near-elderly adults. The researchers are examining the downstream cost implications of uninsurance among the near-elderly. The project examines the following key policy issues:

• the differential impact of gaining Medicare coverage at age 65 on the intensity of health services use and costs of care for previously insured and uninsured adults—using both self-reported and Medicare claims data, we are determining if previously uninsured adults use health services more intensively and receive more costly care as Medicare beneficiaries than previously insured adults with similar characteristics;
• the extent to which gaining Medicare coverage at age 65 increases rates of important diagnoses and slows adverse health and mortality trends for previously uninsured adults relative to previously insured adults;
• the impact of gaining Medicare coverage on subgroups of uninsured near-elderly adults whose health and health care may be most responsive to this coverage, particularly those with chronic conditions;
• the effect of gaining Medicare coverage at age 65 on racial, ethnic, and income disparities in health and mortality.