Are healthier older adults choosing managed care?

Purpose: We attempt to determine whether older workers and early retirees avoid managed care plans and to explore whether health plan choices are linked to the health status of workers or their spouses. Design and Methods: We use the responses of those born between 1931 and 1941 to the 1994 and 1998 waves of the Health and Retirement Survey. We analyze current workers and early retirees separately, using cross-tabular and multinomial logit techniques. Results: Among older adults with active worker coverage, 60% were enrolled in either a health maintenance organization or preferred provider organization in 1998; 42% of early retirees were enrolled in these plans. Those with a choice of plans were even more likely to be in managed care. When demographic characteristics, time, and differences in the benefits and cost of the various plans offered by an employer are controlled for, health status (measured in a variety of ways) has little bearing on an older worker's choice of health plan. Implications: These findings suggest that older workers choose plans much as younger workers do. Employers are likely to continue to offer managed care as their workers age. The lack of unidirectional findings on health status bodes well for the long-term practicality of managed care under Medicare. Many workers are choosing an insurance type early in their tenure and remaining with that type of plan as they age.