@article {9318, title = {Access to Long-Term Care After a Wealth Shock: Evidence from the Housing Bubble and Burst}, number = {Working Paper No. 23781}, year = {2017}, month = {09/2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study (1996-2010), we exploit the exogenous variation in the form of wealth shocks resulting from the value of housing assets, to examine the effect of wealth on use of home health, unpaid help and nursing home care by older adults. We find a significant increase in the use of paid home health care and unpaid informal care but no effect on nursing home care access. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. The findings suggest that a wealth shock exerts a positive and significant effect on the uptake of home health and some effect on unpaid care but no significant effect on nursing home care.}, keywords = {Long-term Care, Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction, Wealth Shocks}, doi = {10.3386/w23781}, url = {http://www.nber.org/papers/w23781.pdf}, author = {Costa-Font, Joan and Richard G Frank and Swartz, Katherine} } @article {7830, title = {Cognition and take-up of subsidized drug benefits by Medicare beneficiaries.}, journal = {JAMA Intern Med}, volume = {173}, year = {2013}, note = {Copyright - Copyright American Medical Association Jun 24, 2013 Last updated - 2013-07-12 SubjectsTermNotLitGenreText - United States--US}, month = {2013 Jun 24}, pages = {1100-7}, publisher = {173}, abstract = {

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{\textquoteright} 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.

}, keywords = {Cognition, Comprehension, Cost Sharing, Eligibility Determination, Health Care Surveys, Humans, Medicare, Medicare Part D, Poverty, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2013.845}, author = {Ifedayo Kuye and Richard G Frank and J. Michael McWilliams} }