Impact of Medicare Age Eligibility on Health Spending among US and Foreign-Born Adults

Objective. Examine differences in health care expenditures between foreign-born and U.S.-born adults in late mid-life, and how these differences change after age 65, when Medicare is near-universal. Data. Medical Expenditures Panel Survey data (2000-2010) on adults ages 5575 years (n = 46,132) to examine annual total and payer-specific expenditures. Study Design. We use (1) propensity score matching to generate quasi-experimental samples with equivalent health needs and health care preferences, (2) generalized linear modeling to estimate group differences in expenditures, and (3) bootstrapping methods to obtain variance estimates for significance testing. Principal Findings. Among adults ages 55-64, the foreign-born spend $3,314 (p<.001) less on health care, even when they have equivalent health needs and health care preferences. This difference is due mainly to lower spending through private insurance. After age 65, differences in total spending disappear but not differences in payer-specific spending. The foreign-born continue to spend significantly less through private insurance and begin to spend significantly more through Medicare and Medicaid. Conclusion. Foreign-born adults in late mid-life spend significantly less on health care than U.S.-born adults. After age 65, with near-universal Medicare coverage, differences in total spending disappear between the groups, although differences in spending by payer persist.