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


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.


Medicaid Health care costs Disability Cognitive impairment Medicare 



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


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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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