Younger Medicare beneficiaries with disabilities are much more likely than seniors in the program to report problems accessing and paying for needed medical services, Kaiser Family Foundation researchers report in a Web First article published today by Health Affairs.
Based on a national random-sample survey of people on Medicare, the study finds that half of nonelderly disabled beneficiaries report problems paying for health care services in the previous 12 months – nearly three times the rate reported by seniors (50 percent compared with 18 percent). Similarly, 46 percent of nonelderly beneficiaries with disabilities report delaying or not getting health care services because of cost, compared with 16 percent of seniors.
In terms of access, a larger share of nonelderly beneficiaries with disabilities report difficulties finding a doctor who would accept Medicare in the past year than seniors (12 percent compared with 4 percent). The disparities persist after adjusting for differences across the populations in terms of health status, income, supplemental coverage and other factors.
The survey finds that nearly one in three younger Medicare beneficiaries with disabilities report that they were uninsured for at least part of the two-year waiting period before qualifying for Medicare coverage. The recently enacted health reform law will provide new options for nonelderly people with disabilities who are awaiting Medicare eligibility to obtain coverage, through high-risk pools beginning this year, and other public and private plans beginning in 2014.
The health reform law “promises substantial help to those in Medicare’s waiting period, as it does to other uninsured individuals - particularly those who would otherwise have difficulty finding affordable coverage because of their medical histories or relatively limited incomes,” write authors Juliette Cubanski and Tricia Neuman of the Foundation.
Even with health insurance, people with disabilities are likely to face ongoing challenges if their coverage does not provide the services and supports they need to live independently, the study suggests. About 15 percent of nonelderly people with disabilities on Medicare report difficulties in finding a doctor who understands how to treat their disability.
The study, conducted in late 2008 and early 2009, is based on a national mail and phone survey of 3,913 non-institutionalized Medicare beneficiaries, including 2,288 beneficiaries under age 65 who qualify for Medicare because of a permanent disability. This group accounts for 8 million of Medicare’s 47 million beneficiaries. The survey provides a detailed look at their experiences with the program, in comparison to the senior population.
Other key findings from the study include:
* One in four Medicare beneficiaries with disabilities under age 65 do not have any supplemental coverage, about twice the share of seniors. Among the under-65 disabled who lacked supplemental coverage, nearly six in 10 reported problems paying for one or more health care services, such as doctor visits and hospital services.
* Medicaid is the most common form of supplemental coverage for the nonelderly disabled on Medicare; these “dual eligibles” report having fewer cost and access-related problems than Medicare beneficiaries with other types of supplemental coverage.
* A larger share of nonelderly disabled than elderly enrollees in Medicare Part D drug plans report difficulty getting a medication because it was not covered by their Part D plan, as well as delaying or not getting medications, or skipping or taking smaller doses because of cost.
The article by Cubanski and Neuman,Medicare Doesn’t Work As Well For Younger, Disabled Beneficiaries As It Does For Older Enrollees, will appear in the September issue of Health Affairs.