Document Type


Publication Date


Focus Area

Social Determinants of Health



As of April 2023, 25% of Vermonters were enrolled in Medicare. Among Medicare beneficiaries nationally, half spent at least 12% of their income on healthcare costs, and one-quarter spent at least 23%. The purpose of this project is to understand healthcare affordability for low-income Vermonters transitioning to Medicare.


An electronic survey about perceptions of healthcare affordability was sent to Vermont primary care providers. Interviews were conducted with a patient, providers, and support services including Community Health Workers (CHW), Community Health Team (CHT), and financial programs. De-identified interviews were coded to identify themes.


The interviewed patient expressed emotional distress over the complex and confusing transition from Medicaid to Medicare. Support services expressed concern that difficulty navigating the system can lead to financial penalties to patients and impact decisions about receiving care.

During interviews, providers expressed frustration over cost and coverage limiting patients’ access to care. The confines Medicare coverage caused providers to prescribe less ideal medications. 77% of those who responded to the survey agree that patient insurance status or ability to afford care may influence recommendations for treatment.


Navigating a transition to Medicare is daunting for patients, both in its complexity and cost. Increases in out-of-pocket costs for patients cause emotional distress and impact their ability to receive optimal care. This project emphasizes the need for stakeholders, such as advocates, lawmakers, and the medical community, to focus their efforts on addressing and understanding how medical debt and affordability impact access to healthcare and health outcomes for low-income Vermonters.


AHEC Scholars Summer Project

Presented at the Vermont Medical Society Annual Meeting on November 3, 2023

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

VMS Presentation (1).pdf (583 kB)
Presented at VMS Annual Meeting