A variety of approaches to expanding access to health coverage to those who are currently uninsured or underinsured have been proposed as part of the broader health care reform debate. Some proposals to expand coverage for uninsured Americans include a policy to allow people who do not now qualify for Medicare to pay a premium and join the program and receive benefits. Commonly, this approach targets adults in their 50s and early 60s who may face unique challenges accessing health coverage. As Medicare is a stable, well-regarded public insurance program, this idea holds great policy appeal. However, a key question is whether buying into the program will be an attractive, affordable option for people in this age group. To help answer the question, we review the general advantages and disadvantages to a Medicare buy-in program in relation to the population in their 50s and early 60s, discuss recent proposals, and identify a number of design questions for a Medicare buy-in program.
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