Health Affairs

Sue Ducat
Director of Communications
(301) 841-9962
sducat@projecthope.org

From Health Affairs

Nonelderly Medicare Beneficiaries: Access And Costs More Problematic

Bethesda, MD--A new study released today by Health Affairs focuses on an often-neglected segment of Medicare enrollees: people ages 18-64 with permanent disabilities, a group that currently numbers eight million, or roughly one-sixth of the total number of Americans in Medicare. The 2008 survey of a nationally representative survey of noninstitutionalized Medicare beneficiaries was designed and conducted by researchers at the Kaiser Family Foundation to assess how well Medicare is working for this group.

Medicare Doesn't Work As Well For Younger, Disabled Beneficiaries
As It Does For Older Enrollees
By Juliette Cubanski and Patricia Neuman
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0962

Juliette Cubanski and Patricia Neuman are affiliated with the Medicare Policy Project at the Kaiser Family Foundation, in Washington, D.C.; Cubanski is the project's associate director, and Neuman is its director and a Foundation vice president.

The sample survey of 3,913 beneficiaries was drawn from administrative data provided by the Centers for Medicare and Medicaid Services (CMS) and included 2,288 people ages 18-64 with permanent disabilities and 1,625 respondents age 65 and older. The nonelderly disabled beneficiaries were twice as likely to have five or more chronic medical conditions, more than twice as likely to have felt sad or depressed during the previous year, and four times as likely to have experienced severe pain in the previous four weeks.

Some of the major findings:

•   Half of the nonelderly beneficiaries reported problems paying for health care services in the previous twelve months, versus 18 percent of the elderly population. Similarly, 46 percent of the nonelderly group reported delaying or not getting health care services because of cost, compared to 16 percent of senior enrollees.

•   Nearly one in three Medicare beneficiaries with disabilities reported that they were uninsured for at least part of the two-year waiting period before qualifying for Medicare.

•   Nearly one in four nonelderly disabled beneficiaries lacked supplemental coverage, about twice the proportion of the elderly group.

•   For nonelderly Medicare beneficiaries, Medicaid is the most likely supplemental coverage option; this group has nearly four times the rate of Medicaid supplemental coverage of the senior group.

•   Nonelderly disabled enrollees in Medicare Part D drug plans were almost three times as likely to report difficulty in obtaining a medication because it was not covered by the plan (37 percent versus 13 percent of the elderly) and more than twice as likely to skip or take smaller doses because of the cost (26 percent versus 12 percent).

This year's health reform is likely to address some of the problems highlighted by this study. "One of the less-heralded but important aspects of the Affordable Care Act is its potential to help people with disabilities, including those in Medicare's waiting period, by broadening access to public and private health insurance coverage, improving Medicare Part D coverage, and introducing reforms designed to improve the coordination and quality of care," conclude the authors. "As policy makers focus their attention on reforms designed to increase insurance coverage and reduce health care costs, evaluating how well the implementation of the Affordable Care Act improves coverage and care for people with disabilities will provide an important test of its impacts."

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at http://www.healthaffairs.org/. The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.