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Journal of Urban Health

, Volume 93, Issue 5, pp 840–850 | Cite as

Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults

  • Amber WillinkEmail author
  • Karen Davis
  • Cathy Schoen
  • Jennifer Wolff
Article

Abstract

While Medicare provides health insurance coverage for those over 65 years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30 %. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.

Keywords

Medicaid Health care costs Disability Cognitive impairment Medicare 

Notes

Acknowledgments

This work was made possible by funding from the Commonwealth Fund (20160346).

References

  1. 1.
    Paradise J. Medicaid Moving Forward. Kaiser Fam Found Issue Br. 2015. Available at: http://kff.org/health-reform/issue-brief/medicaid-moving-forward. May 2016.
  2. 2.
    Komisar HL, Feder J. Transforming care for medicare beneficiaries with chronic conditions and long-term care needs: coordinating care across all services. Washington, DC: Georgetown University; 2011.Google Scholar
  3. 3.
    Schoen C, Buttorff C, Andersen M, Davis K. Policy options to expand medicare’s low-income provisions to improve access and affordability. Health Aff. 2015; 34(12): 2086–94.CrossRefGoogle Scholar
  4. 4.
    Wiener JM, Anderson WL, Khatutsky G, Kaganova Y, O’Keeffe J. Medicaid spend down: new estimates and implications for long-term services and supports financing reform. Washington, DC: RTI International; 2013.Google Scholar
  5. 5.
    Brown JR, Finkelstein A. The interaction of public and private insurance: medicaid and the long-term care insurance market. Am Econ Rev. 2004; 98(3): 1083–1102.Google Scholar
  6. 6.
    Chien S, Campbell N, Chan C, et al. RAND HRS data documentation, version O. Washington, DC; 2015. http://hrsonline.isr.umich.edu/modules/meta/rand/randhrso/randhrs_O.pdf. Accessed May 2015.
  7. 7.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. J Am Med Assoc. 1963; 185(12): 914–9.CrossRefGoogle Scholar
  8. 8.
    Crimmins EM, Kim JK, Langa KM, Weir DR. Assessment of cognition using surveys and neuropsychological assessment: the health and retirement study and the aging, demographics, and memory study. J Gerontol Ser B Psychol Sci Soc Sci. 2011; 66B(Supplement 1): i162–71.CrossRefGoogle Scholar
  9. 9.
    Langa KM, Plassman BL, Wallace RB, et al. The aging, demographics, and memory study: study design and methods. Neuroepidemiology. 2005; 25(4): 181–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Ofstedal MB, Fisher GG, Herzog AR. Documentation of cognitive functioning measures in the health and retirement study. Ann Arbor, MI: University of Michigan; 2005. p. 10.Google Scholar
  11. 11.
    Schoen C, Doty MM, Collins SR, Holmgren AL. Insured but not protected: how many adults are underinsured? Health Aff. 2005; 24: W5.Google Scholar
  12. 12.
    Collins SR, Gunja M, Doty MM, Buetel S. How high is America’s health care cost burden? Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July-August 2015. Issue Brief (Commonw Fund). 2015; 32: 1–15.Google Scholar
  13. 13.
    Hurd MD, Rohwedder S. The level and risk of out-of-pocket health care spending. Michigan Retirement Research Center, Ann Arbor, MI, USA. 2009; p. 218.Google Scholar
  14. 14.
    Zissimopoulos J, Goldman D, Lu Y. Medical expenditure measures in the health and retirement study. Forum Health Econ Policy. 2011; 14(3): 4. doi: 10.2202/1558-9544.1267.
  15. 15.
    Borella M, De Nardi M, French E. Rich, poor, singles, and couples. Who Receives Medicaid in old age and why? (No. w21873). National Bureau of Economic Research, Cambridge, MA, USA; 2016.Google Scholar
  16. 16.
    Davis K, Willink A, Schoen C. Medicare help at home. Heal Aff Blog. 2016. Available at: http://healthaffairs.org/blog/2016/04/13/medicare-help-at-home/. April 2016.
  17. 17.
    Gawande A. Being mortal: medicine and what matters in the end. Metropolitan Books, New York, NY, USA; 2014.Google Scholar
  18. 18.
    Moon M, Hollin IL, Nicholas LH, Schoen C, Davis K. Serving older adults with complex care needs: a new benefit option for Medicare. Issue Brief (Commonw Fund). 2015; 23: 1–11.Google Scholar
  19. 19.
    Szanton SL, Samuel L, Wolff JL, Thorpe RJ, Mohamoud S, Betley C. Public benefits reduce risk for nursing home entry among Maryland’s dual eligible older adults. In: Academy Health Annual Research Meeting. Academy Health, Minneapolis MN; 2015.Google Scholar

Copyright information

© The New York Academy of Medicine 2016

Authors and Affiliations

  1. 1.Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  2. 2.New York Academy of MedicineNew YorkUSA

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