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The AARP Public Policy Institute focuses on issues of critical importance as we age. Below we highlight research, analysis, background and commentary on Medicare.

Culture of Health Initiative

AARP Well-Being ChampionsSM

When it comes to catalyzing a Culture of Health in America’s communities, creative solutions are emerging to promote well-being. As a means of fostering that trend, the AARP Public Policy Institute has launched a Culture of Health initiative to champion change across America in the areas of health and well-being. Meet a group of 10 leaders who saw a challenge before them in their own communities and responded. Read

Recent Analysis

Millions of People Pay Medicare Late-Enrollment Penalties for Life after Missing Key Deadlines

This Spotlight report describes Medicare’s enrollment rules, the situations in which late-enrollment penalties apply (and when they don’t), how many people are paying these penalties, and who is most likely to incur penalties. Read

The Importance of Prescription Drugs to Midlife Medicaid Enrollees

This Fact Sheet considers how adults ages 50 to 64 enrolled in Medicaid, hereafter “midlife Medicaid enrollees,” use one Medicaid benefit: outpatient prescription drugs. Read.

A New Era for State Pharmaceutical Assistance Programs That Serve Older Adults

This report examines the existing State Pharmaceutical Assistance Programs (SPAPs) and their characteristics and highlights how specific federal prescription drug reforms could generate savings for SPAPs. Read.

Trends in Retail Prices of Prescription Drugs Widely Used by Older Americans, 2006 to 2020

This report is the latest in the AARP Public Policy Institute’s Rx Price Watch series and presents both annual and 15-year cumulative price changes through the end of 2020 for a combined set of 943 prescription drugs widely used by older adults. Read.

Food Insecurity Increased to 1 in 10 Adults Ages 50 and Older in 2022

This AARP Public Policy Institute Fact Sheet describes trends in food insecurity and selected characteristics of food-insecure adults ages 50 and older. Read.

Medicare Savings Program Enrollment Increases When States Expand Financial Eligibility Criteria

This AARP Insight reports findings from an analysis of MSP enrollment patterns in a sample of four states before and after the states expanded MSP eligibility criteria. Read.

Policy Options to Improve Older Adults’ Health Insurance Affordability

A new series of four briefs explores a range of state and federal policy options that could increase access to affordable health insurance and potentially reduce health disparities among individuals ages 50 to 64. Read.

Eliminating Access to No-Cost Preventive Health Services Could Affect More Than 12 Million Adults Ages 50 to 64

A Texas federal court recently ruled that the Affordable Care Act (ACA) provision of requiring most private health insurers to cover recommended preventive services without cost-sharing was unconstitutional, putting access to no-cost critical preventive health services in jeopardy for millions of Americans. Read.

Medication Literacy Series: Drug Formularies

This fact sheet highlights the essential components of drug formularies and considers the challenges that older adults face when responding to the impacts and implications of formularies annually and throughout the plan year. Read.

Trends in Retail Prices of Generic Prescription Drugs Widely Used by Older Americans, 2006 to 2020

The findings of this report highlight the pricing dynamics in the generic drug market when compared with those in the brand name drug market. Read.

Prices for Top Medicare Part D Drugs Have More Than Tripled Since Entering the Market

This Spotlight report finds that list prices for 25 top Medicare Part D drugs have increased by an average of 226 percent—or more than tripled—since they first entered the market, greatly exceeding the corresponding rate of general inflation. Read.

9.4 Million Adults Ages 50 and Older Faced Food Insecurity in 2021

Over 9 million Americans ages 50 and older (about eight percent) were food insecure in 2021, meaning they had limited or uncertain access to adequate, nutritious food. Read.

Racial and Ethnic Disparities Remain in Health Insurance Coverage Among Adults Ages 50 to 64

This report  includes national data on racial and ethnic disparities in coverage and access among older adults, from 2012 (two years prior to the implementation of the ACA) through 2021, the eighth full year of Marketplace operations. Read.

Medication Literacy Series: Medication Management

This Fact Sheet explores the range of formal medication management programs that are available and the challenges that older adults, especially those with limited medication literacy and their family caregivers face when trying to manage their medications. Read.

Improving SNAP Uptake Among Eligible Older Adults: Federal Policy Options to Simplify and Streamline Administrative Processes

This paper proposes four federal policy options that build on documented successful efforts to improve SNAP access and participation among eligible older adults. Read.

Health Care Coverage, Affordability, and Access Among Rural and Urban Adults Ages 50 to 64

This analysis examines rural–urban differences in health care coverage, affordability, and access over time from 2012, two years prior to implementation of the ACA, through 2019, the sixth full year of ACA Marketplace operations. Read.

Resumption of Medicaid Eligibility Reassessments: Over 1 Million Enrollees Ages 50 to 64 Could Lose Their Benefits

Prior to the COVID-19 pandemic, state Medicaid programs typically reassessed enrollees’ eligibility at least once a year and would disenroll them if they no longer qualified. The pandemic put that practice on hold, leading to record high Medicaid enrollment and record low levels of uninsured Americans. Read

Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care

This report uses available data to detail actual health care spending by people enrolled in traditional Medicare and shows how large the financial burden of health care is for this group of Medicare beneficiaries based on costs relative to income. Read

Improving Medicare Advantage Payment Policy While Focusing on Implications for Consumers

This report identifies the key features of the complex Medicare Advantage (MA) payment system that contribute to its higher costs to the Medicare program. Read

Underused Medicare Savings Programs Can Help Many More Older Adults Afford Health Care

Medicare Savings Programs (MSPs) help low-income older adults pay Medicare premiums and other out-of-pocket costs. However, historically, MSP enrollment has been low, despite efforts over the years to increase participation. Read

Medication Literacy Series: Generic Drugs

This fact sheet reviews some potential barriers that older adults face when accessing generic drugs, the lower-cost versions of brand-name drugs that enter the market after a brand-name drug’s monopoly period ends. Read

Medication Literacy Series: Prescription Drug Container Labels

Standardized, consumer-centered improvements to the style, organization and content of prescription drug container labels may help consumers manage their medications and, importantly, reduce medication errors. Read

State Biosimilar Substitution Laws Could Reduce Consumer Access and Savings

Consumers facing high costs for prescription drugs can see substantial savings when they switch from a brand-name drug to a generic equivalent, but this option is not yet widely available for biologic drugs. This fact sheet examines biosimilar substitution laws in each state that may be affecting consumer access. Read

Influenza, Pneumonia, and Shingles Vaccinations Rise among Older Adults, but Disparities Continue

This Fact Sheet examines the prevalence of influenza, pneumonia, and shingles vaccinations among adults ages 50 and older in 2020. Vaccinations for all three diseases increased from 2019, yet racial and ethnic disparities continue. Read

Utilization Management for Prescription Drugs Commonly Used by Older Adults: Wide State Variation Among Top Marketplace Plans

This Fact Sheet examines prescription drug utilization management (UM) among the top 10 marketplace plans in all 50 states and the District of Columbia and finds considerable variation among states in UM for prescription drugs commonly used by adults 50 to 64. Read

Boosting SNAP Participation Among Older Adults to Reduce Food Insecurity

A series of three AARP Public Policy Institute and Mathematica Spotlight reports analyze SNAP participation among older adults and the policies that affect it. Read

Trends in Utilization Management of Prescription Drugs in Top Marketplace Plans

This paper discusses and examines utilization management (UM) trends in top 10 marketplace prescription drug plans between 2016 and 2020. Read

Over 9 Million Adults Ages 50 and Older Faced Food Insecurity in 2020

This fact sheet describes trends in food insecurity and selected characteristics of food-insecure adults ages 50 and older. State-level data are included in the appendix. Read

Medication Literacy: A Helpful Concept for Understanding Medication Decision Making among Older Adults

While health literacy is widely understood as a quality measure of health care decision making, another related measure calls for increased attention, particularly regarding older adults: medication literacy.  Read

Millions of Adults Ages 50 and Older Rely on the Supplemental Nutrition Assistance Program (SNAP)

This fact sheet describes selected characteristics of adults ages 50 and older who participate in the Supplemental Nutrition Assistance Program (SNAP) and the benefits their households receive. The paper includes analysis of SNAP participants ages 50 to 59 as well as those ages 60 and older, and state-level data is included in the appendices. Read

Home and Community-Based Services for Older Adults

In light of COVID-19’s devastating impact on nursing homes and other institutional care settings, more and more older adults with long-term care needs and their families are interested in home and community-based care options. This new AARP primer provides the latest data and information on HCBS, including what it encompasses, who the users and providers are, how it is financed, and several delivery models and policy solutions that states could expand to improve and expand access to these services. Read

Rural–Urban Health Disparities among US Adults Ages 50 and Older

This AARP fact sheet analyzes indicators of health care access, health-related behaviors, and health conditions among the 50 and older age group living in rural and urban areas. The analysis also explores racial and ethnic differences in health among older adults living in rural and urban areas to assess whether health disparities by racial and ethnicity are exacerbated by residence in a rural area. Read

An Opportunity to Improve Nursing Facility Immunization Programs

This report examines the pre-pandemic immunization environment in nursing facilities, explores how facilities administered immunization during different periods of the pandemic, and highlights issues that states and facilities should consider as they evaluate whether and how their immunization programs can be modified or improved. Read

Trends in Retail Prices of Specialty Prescription Drugs Widely Used by Older Americans, 2006 to 2020

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen W. Schondelmeyer finds that retail prices for widely used specialty prescription drugs increased by an average of 4.8 percent between in 2020, more than three-and-a-half times faster than inflation. Read

Estimating Impacts of Pandemic-Related Job Loss on Health Insurance Coverage among Adults Ages 50 to 64 During the First Year of COVID-19

New analysis examines the impact of the COVID-19 pandemic on health insurance coverage for older adults ages 50 to 64. Read

Novel Anticoagulants Achieve Rapid Market Penetration despite Higher Costs

This paper focuses on the rapid market penetration of a novel therapeutic option for stroke prevention among patients with atrial fibrillation. The observed widespread shift in prescribing practices led to substantial increases in spending, as the new products were approximately 20 times more expensive than comparable existing products. Read

Concurrent Anticholinergic and Acetylcholinesterase Inhibitor Drug Use Among Older Adults with Dementia: Commonly Done; Never Advised

This study was designed to determine if anticholinergic use among older adults with dementia taking AChEI puts them at higher risk for adverse outcomes and concludes that it does. Older adults with dementia who had concomitant anticholinergic and AChEI use were 18 percent more likely to experience a fall, 16 percent more likely to have a fracture, and 25 percent more likely to have a traumatic brain injury (TBI) than those taking AChEI alone. Read

Rx Price Watch Report: Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans, 2006 to 2020

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen W. Schondelmeyer finds that retail price increases for widely used brand name prescription drugs consistently exceeded the rate of general inflation between 2006 and 2020. Read

Drug Price Increases That Exceed Inflation Are Costing Medicare Part D Billions

This AARP Public Policy Institute Spotlight finds that Medicare Part D is spending billions on drug prices that are increasing faster than inflation. Read

The COVID-19 Vaccine Rollout: How the Current Vaccine Environment Could Impact Uptake among Adults 50 and Older

This report examines the current vaccine landscape and explores how key factors— including unfavorable attitudes toward vaccines and vaccination access and infrastructure—may limit the number of adults ages 50 and older receiving COVID-19 vaccines. Read

Vaccine Hesitancy among Older Adults, with Implications for COVID-19 Vaccination and Beyond

This report explores vaccine hesitancy among older adults, the attitudes that drive vaccine hesitancy, and the relationship between hesitancy toward the influenza vaccine and hesitancy toward COVID-19 vaccines. Read

Influenza Vaccinations among Adults 50 and Older: Slow Progress over the Past Decade

Because of the COVID-19 pandemic, there is a real urgency to get more people vaccinated against the flu this year. But older adults, who are most at risk of serious illness and death from both COVID-19 and seasonal flu, are, in an effort to avoid the coronavirus, skipping opportunities to get their annual influenza vaccine. Read

Rx Price Watch Report: Trends in Retail Prices of Prescription Drugs Widely Used by Older Americans, 2017 Year-End Update 

Retail prices for widely used prescription drugs increased by an average of 4.2 percent in 2017. In contrast, the general inflation rate was 2.1 percent over the same period.  Read

Annual Wellness Visits among Medicare Advantage Enrollees

Trends, Differences by Race and Ethnicity, and Association with Preventive Service Use. Read

Specialty Drugs in Breast Cancer: Health Care Utilization and Costs in the First Year after Diagnosis

This Spotlight is based on an analysis of administrative claims data from the OptumLabs Data Warehouse. In our sample of Medicare Advantage beneficiaries ages 50 and older with breast cancer, the health care costs in the first year after diagnosis averaged $120,000. Read

The Facts about Prediabetes and Older Americans

Nearly half of US adults ages 65 and older – more than 23 million people -- have prediabetes—blood sugar levels that are higher than normal but not high enough to be considered diabetes.  Nine out of 10 people with prediabetes do not even know they have the condition, and many do not realize that prediabetes is a serious health concern that increases risk for developing type 2 diabetes, heart disease, and stroke. Read

Reducing Potential Overuse of Dementia Drugs Could Lead to Considerable Savings

Dementia medications typically provide modest, short-term benefits and therefore are not intended for long-term use. Nevertheless, findings from a new AARP Public Policy Institute (PPI) report indicate that some adults with dementia remained on these drugs for as long as a decade, increasing the potential for adverse health outcomes and  costing nearly $20,000. Read

Using Telehealth to Improve Home-Based Care for Older Adults and Family Caregivers

This paper describes the consumer perspective on the value of telehealth and the current policy concerns with this avenue of health care delivery. This consumer perspective is provided by AARP’s Public Policy Institute on behalf of older adults and their family caregivers. Read

Off-Label Antipsychotic Use in Older Adults with Dementia: Not Just a Nursing Home Problem

This Spotlight is based on an analysis of administrative claims data from the OptumLabs Data Warehouse. In our sample of Medicare Advantage beneficiaries ages 65 and older with dementia living in the community, antipsychotic (AP) use increased by 6% between 2012 and 2015, from 12.6% to 13.4%. Read

Supplemental Nutrition Assistance Program (SNAP) Provides Benefits for Millions of Adults Ages 50 and Older

This fact sheet provides an overview of the SNAP program’s eligibility criteria and provides state-level data on benefits, household composition, and participation for SNAP households with older adults. Read

How Big is the Problem of Low-Value Health Care Service Use?

This Spotlight describes the use of low-value health care services by private plan enrollees age 50+. Read

Rx Price Watch Report: Trends in Retail Prices of Prescription Drugs Widely Used by Older Americans: 2006 to 2015

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen W. Schondelmeyer finds that retail prices for widely used prescription drugs increased, on average, between 2006 and 2015. In 2015, retail prices for 768 brand name, generic, and specialty prescription drugs widely used by Medicare beneficiaries increased by an average of 6.4 percent. In contrast, the general inflation rate was 0.1 percent over the same period. Read

Medicare Spends More on Socially Isolated Older Adults

Studies have shown that socially isolated older adults are at greater risk for poor health and death than their well-connected counterparts. Now a new study—the first to examine whether social isolation also affects health care spending among older adults—finds that a lack of social contacts among older adults is associated with an estimated $6.7 billion in additional Medicare spending annually. Read

Implantable Medical Devices: A closer look at issues related to regulatory oversight and cost

Implantable devices, like cardiac pacemakers and artificial hips, are a central part of medical treatment today. As the population has aged and technology has advanced, the range of implantable devices and the number that are being inserted in people have increased dramatically. As a result, AARP’s Public Policy Institute is taking a closer look at issues related to the regulatory oversight and cost of these devices. Read

Prescription Drug Abuse among Older Adults

Prescription drug abuse is a serious and growing public health problem, and older adults are not immune to the growing problem. This Insight on the Issues examines age-related differences in prescription drug misuse, describes various challenges unique to the older population and offers broad recommendations to address those challenges. Read

Rx Price Watch Report: Trends in Retail Prices of Specialty Prescription Drugs Widely Used by Older Americans: 2006 to 2015

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen W. Schondelmeyer finds that retail prices for widely used specialty prescription drugs increased, on average, between 2006 and 2015. In 2015, retail prices for 101 widely used specialty prescription drugs increased by an average of 9.6 percent—the highest average annual increase since at least 2006. Read

Should Race and Ethnicity Be Factored into Prostate Cancer Screening Guidelines?

This spotlight is based on an analysis of administrative claims data from the OptumLabs Data Warehouse. We found substantial racial and ethnic differences in PSA screening and prostate cancer diagnoses between 2009 and 2014. Read

Disparities in Diabetes Prevalence Among Older Adults

While diabetes affects Americans of all ages, older adults are disproportionately affected. In a recent analysis, we found that 23 percent of Americans ages 65 and older in 2015 reported having been diagnosed with diabetes (Table 1). The stark racial and ethnic disparities in diabetes prevalence among older adults are particularly concerning—about 20 percent of whites reported a diabetes diagnosis, compared to 35 percent of both blacks and Hispanics. Read

Rx Price Watch Report: Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans: 2006 to 2015

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen Schondelmeyer finds that retail prices for widely used brand name prescription drugs increased substantially faster than general inflation between 2006 and 2015, and that the difference between the rate of brand name drug price increases and the rate of general inflation has been widening. Read

Few Hip Fracture Patients Receive Osteoporosis Care

This spotlight is based on an analysis of insurance claims data from the OptumLabs Data Warehouse. We found that surprisingly few women are evaluated or treated for osteoporosis following hip fractures, and these missed opportunities may leave some patients at increased risk for subsequent fractures. Read

Share of the Population 85+, in 2015 and 2050, by State

How many people are age 85-plus in your state, and how much is this population projected to grow? Find out here: Read

Taking a Closer Look at American Indians and Alaska Natives Ages 50 and Older

This report outlines the demographics of this growing cohort and concludes with recommendations for coordi­nating programmatic resources to better serve it. Read

Hospital Readmission Rates Falling Among Older Adults Receiving Joint Replacements

Rates of unplanned hospital readmissions following elective hip and knee replacement procedures fell markedly among the 50- to 84-year-old population between 2009 and 2013. Read

Observation Status: Financial Implications for Medicare Beneficiaries

Do Medicare beneficiaries face higher out-of-pocket costs when they remain in observation status rather than being admitted as hospital inpatients? Read

Star Power

The effect of Angelina Jolie’s personal story of BRCA1 mutation on testing rates among commercially insured women.  Read

Transforming the Workforce to Provide Better Chronic Care

First in a series looking at innovative projects around the country. This report: The role of nurses in Rhode Island. Read

Use of Clinical Preventive Services and Prevalence of Health Risk Factors Among Adults Aged 50-64

A national and state-level look at how Americans 50-64 underuse preventive services and face considerable health challenges. Read

Rapid Growth in Hospital Observation Services: What’s Going On?

How does increasing use of hospital observation services by Medicare beneficiaries impact cost and quality of care? Read

Beyond 50 Chronic Care: A Call to Action for Health Reform

This ninth volume of Beyond 50 paints a portrait of chronic illness from the consumer perspective. Focus groups and surveys conducted for the study provide a unique look at how patients and caregivers experience the health care system and the challenges of coordinating care. Read

Susan Reinhard is senior vice president and director of AARP Public Policy Institute. Read her latest blogs on family caregiving, healthy living, nursing and more. Read Susan's Blogs