Medicare eligibility is associated with increasing access to health care for low-income adults

Medicare eligibility is associated with increasing access to health care for low-income adults

According to a new study published October 4 in the open access journal PLOS Medicine by Rishi Wadhera of Beth Israel Deaconess Medical Center and Harvard Medical School, USA, and colleagues, Medicare eligibility and enrollment are associated with declines in the proportion of low-income adults who delay or avoid medical care because of cost, as well as with the proportion of those who are worried or have problems paying medical bills.

In the United States, low-income adults are more likely than higher-income adults to lack health insurance coverage, face barriers to accessing health care, and experience disproportionate financial burdens due to health care expenses. The Medicare program provides health insurance coverage to more than 50 million older adults in the United States.

In the new study, researchers used cross-sectional data from the 2019 US National Health Interview Survey on 1.66 million low-income adults aged 64, just below the Medicare eligibility threshold at age 65, and 1.49 million low-income Medicare-eligible adults aged 66 with similar baseline characteristics other than age and Medicare eligibility. The study also included a higher-income cohort with 2.11 million adults age 64 and 2.17 million adults age 66.

For low-income adults, Medicare eligibility at age 65 was associated with improvements in several areas. Among low-income 64-year-olds, 14.7% delayed care due to cost and 15.5% forwent care, while among low-income 66-year-olds only 6.2% missed care due to cost and 5.9% delayed care, a decrease of 8.5% (95% CI: -14.7% to -2.4%, P = 0.007) and 9.6% (-15.9% to -). 3.2%, P=0.003). There were also significant declines in measures of financial burden; At age 64, 66.5% of low-income adults were worried about medical bills and 33.9% had difficulty paying medical bills. At age 66, 51.1% were worried and 20.6% had difficulty paying medical bills, a decrease of 15.4% (-25.4% to -5.4%, P=0.003) and 13.3% (-23.0% to -3.6%, P=0.007). Among higher-income adults, the results were more modest and less consistent. Medicare was not associated with changes in the percentage of low- and upper-income adults experiencing cost-related barriers to medication use.

“As the debate over whether to lower the age of Medicare eligibility continues in the United States, policymakers should consider the potential impact of this measure on access and affordability of health care for low-income adults and on health equity more broadly,” the authors say.

Wadhera adds, "More than 40% of U.S. adults under age 65 are either uninsured or underinsured. The majority of Americans do not become eligible for Medicare coverage until age 65, and our results suggest that this transition will be associated with significant improvements in health care access, affordability, and a reduction in financial burden for low-income and lower-income adults." Measures associated with higher income adults. As policymakers debate whether to expand the Medicare program, "Our study provides evidence that lowering the Medicare eligibility age can improve health equity in the United States."

Source:

PLUS

Reference:

Aggarwal, R., et al. (2022) Medicare eligibility and health care access, affordability, and financial burden for low- and upper-income adults in the United States: A regression discontinuity analysis. PLoS Medicine. doi.org/10.1371/journal.pmed.1004083.

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