Cognition and take-up of subsidized drug benefits by Medicare beneficiaries.

TitleCognition and take-up of subsidized drug benefits by Medicare beneficiaries.
Publication TypeJournal Article
Year of Publication2013
AuthorsKuye, I, Frank, RG, McWilliams, JM
JournalJAMA Intern Med
Date Published2013 Jun 24
ISSN Number2168-6114
KeywordsCognition, Comprehension, Cost Sharing, Eligibility Determination, Health Care Surveys, Humans, Medicare, Medicare Part D, Poverty, United States

IMPORTANCE: Take-up of the Medicare Part D low-income subsidy (LIS) by eligible beneficiaries has been low despite the attractive drug coverage it offers at no cost to beneficiaries and outreach efforts by the Social Security Administration.

OBJECTIVE: To examine the role of beneficiaries' cognitive abilities in explaining this puzzle.

DESIGN AND SETTING: Analysis of survey data from the nationally representative Health and Retirement Study.

PARTICIPANTS: Elderly Medicare beneficiaries who were likely eligible for the LIS, excluding Medicaid and Supplemental Security Income recipients who automatically receive the subsidy without applying.

MAIN OUTCOMES AND MEASURES: Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions.

RESULTS: Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5% vs 52.0%; P = .002), LIS awareness (58.3% vs 33.3%; P = .001), and LIS application (25.5% vs 12.7%; P < .001). Lower numeracy was also associated with lower rates of Part D enrollment (P = .03) and LIS application (P = .002). Reported receipt of the LIS was associated with significantly lower annual out-of-pocket drug spending (adjusted mean difference, -$256; P = .02) and premium costs (-$273; P = .02).

CONCLUSIONS AND RELEVANCE: Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors.


Copyright - Copyright American Medical Association Jun 24, 2013 Last updated - 2013-07-12 SubjectsTermNotLitGenreText - United States--US

User Guide Notes

Endnote Keywords

Self assessed health/Medicare/Medicare Part D/Out of pocket costs/Beneficiaries/Government subsidies/Cognitive ability/Eligibility/Health care expenditures/Health care policy

Endnote ID


Alternate JournalJAMA Intern Med
Citation Key7830
PubMed ID23649604
PubMed Central IDPMC3692587
Grant ListK08 AG038354 / AG / NIA NIH HHS / United States
P01 AG032952 / AG / NIA NIH HHS / United States