Evaluating access to care for Medicare beneficiaries younger than 65 Years.

OBJECTIVES: Individuals younger than 65 years can qualify for Medicare if they have long-term disabilities or certain qualifying conditions. These beneficiaries-particularly the non-dual-eligible population-may experience cost and access barriers to medical care. We examined the association between Medicare coverage type and reported barriers to care.

STUDY DESIGN: Multivariable linear probability models assessed the association between self-reported Medicare coverage and patient-reported outcomes by dual-eligibility status.

METHODS: Using 2012-2020 data from the Health and Retirement Study, we compared self-reported sociodemographic and health-related characteristics of non-dual-eligible and dual-eligible beneficiaries aged 50 to 64 years by Medicare coverage type at their baseline interview. We then examined the following self-reported outcomes: experiencing cost-related medication nonadherence, delaying care due to cost, not having a usual source of care, and having trouble finding a doctor.

RESULTS: Among non-dual-eligible beneficiaries, enrollment in traditional Medicare (TM) plus supplemental coverage vs TM with no supplemental coverage was associated with lower reported rates of experiencing cost-related medication nonadherence (-7.5 percentage point [PP] change; 95% CI, -12.1 to -3.0), delaying care due to cost (-9.8 PP; 95% CI, -13.3 to -6.3), and having no usual source of care (-5.5 PP; 95% CI, -8.9 to -2.1). Compared with TM with no supplement, Medicare Advantage enrollment was associated with lower rates of delaying care due to cost (-4.2 PP; 95% CI, -7.6 to -0.7) and having no usual source of care (-5.2 PP; 95% CI, -8.2 to -2.3). Among dual-eligible beneficiaries, outcomes largely did not differ by coverage type. Switching from traditional Medicare to Medicare Advantage was associated with trouble finding a doctor for dual-eligible beneficiaries.

CONCLUSIONS: Enrollment in less generous Medicare coverage was associated with greater cost and access barriers to care for beneficiaries younger than 65 years.