Loss of Medicare Part D subsidy linked to higher mortality among low-income older adults
For immediate release: May 14, 2025
Boston, MA—While it may seem intuitive that people would die without life-saving medications, researchers at the University of Pennsylvania Perelman School of Medicine and Harvard T.H. Chan School of Public Health have connected losing a federally funded prescription drug assistance program and an increase in mortality. The program, called the Medicare Part D Low-Income Subsidy (LIS), helps 14.2 million low-income Medicare beneficiaries, many of whom are older Americans, afford their medications. Nationally, 12.5 million people who are eligible for and enrolled in both Medicare and Medicaid (“dual eligibles”) automatically qualify for the LIS, which is worth about $6,200/year.
The study was published May 14 in the New England Journal of Medicine. It reveals that losing Medicaid coverage—and with it, the LIS—was associated with significant increases in mortality among low-income Medicare beneficiaries.
“When Medicare beneficiaries lose Medicaid, which happens to more than 900,000 people each year, they also risk losing the LIS and therefore, being able to afford the medicines they need,” said lead author Eric Roberts, associate professor of general internal medicine at the University of Pennsylvania Perelman School of Medicine and a Leonard Davis Institute of Health Economics senior fellow.
The study included nearly 1 million low-income Medicare beneficiaries whose Medicaid coverage ended. Due to program rules, the exact month people lose Medicaid impacts when they are removed from the LIS.
The researchers compared two groups: individuals who lost Medicaid from January to June and were removed from the LIS by the following January (seven to 12 months later), and those who lost Medicaid from July to December and lost the LIS the next January (13 to 18 months later). This allowed the team to compare mortality rates during the period when some had lost the LIS and others had not.
Mortality was four percent higher among individuals who lost the LIS earlier than those who retained it for a longer period. Over the study period, more than 2,900 people died. The risks were even greater among subgroups of people who had greater clinical needs and were on more expensive medications. For example, mortality was 22% higher among people using HIV antiretroviral therapy.
The researchers found that over one half of individuals who lost Medicaid regained it within one year, suggesting that many were dropped from Medicaid despite remaining eligible.
“These findings show that helping low-income Medicare beneficiaries who are eligible for Medicaid stay enrolled and retain the LIS can save lives since it preserves access to essential medications,” said senior author José Figueroa, associate professor of health policy and management at Harvard Chan School.
The authors note that recent increases in Medicaid coverage losses among older adults raise concerns about potential losses of the LIS. Added Roberts, “As policymakers consider major changes to the Medicaid program, preserving Medicaid coverage for older adults is critical to ensuring that they keep the LIS.”
Support for this work came from the National Institute on Aging (R01AG076437; R01AG081151; RF1AG088640; T32AG000037), the Agency for Healthcare Research and Quality (R01HS029453), and Arnold Venture.
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For more information:
Maya Brownstein
mbrownstein@hsph.harvard.edu
Eric Horvath
eric.horvath@pennmedicine.upenn.edu
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