Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy.

TitleOut-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy.
Publication TypeJournal Article
Year of Publication2010
AuthorsBriesacher, BA, Ross-Degnan, D, Wagner, AK, Fouayzi, H, Zhang, F, Gurwitz, J, Soumerai, SB
JournalMed Care
Date Published2010 Jun
ISSN Number1537-1948
KeywordsAdult, Aged, Confidence Intervals, Cost of Illness, Deductibles and Coinsurance, Drug Prescriptions, Female, Financing, Personal, Health Expenditures, Humans, Income, Male, Medicare Part D, Middle Aged, Odds Ratio, Poverty, Socioeconomic factors, United States

BACKGROUND: Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources.

OBJECTIVE: : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility.

RESEARCH DESIGN: Nationally representative cross-sectional study.

SUBJECTS: Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study.

METHODS: We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility.

RESULTS: In the year before Part D, more than half of Medicare families [56.0%; 95% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26% of Medicare families had burdensome health care costs but were not eligible for LIS assistance.

CONCLUSIONS: Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.

User Guide Notes


Endnote Keywords

Low income groups/Medicare/Medicare Part D/Health care expenditures/Prescription drug plans/Families and family life/Insurance premiums/Health insurance/Health care access

Endnote ID


Alternate JournalMed Care
Citation Key7455
PubMed ID20473197
PubMed Central IDPMC3084515
Grant ListK01 AG031836 / AG / NIA NIH HHS / United States
K01 AG031836-02 / AG / NIA NIH HHS / United States
K01 AG 031836 / AG / NIA NIH HHS / United States