Journal of General Internal Medicine

, Volume 21, Issue 11, pp 1144–1149 | Cite as

Changes in health for the uninsured after reaching age-eligibility for medicare

  • David W. Baker
  • Joseph Feinglass
  • Ramon Durazo-Arvizu
  • Whitney P. Witt
  • Joseph J. Sudano
  • Jason A. Thompson
Original Articles

Abstract

BACKGROUND: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance.

OBJECTIVE: To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare.

DESIGN: Prospective cohort study.

PARTICIPANTS: Participants (N=3.419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview.

MEASUREMENTS: We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t−2 to t0) and the following 2 years (t0 to t2).

RESULTS: Between the interview before age 65 (t−2) and the first interview after reaching age 65 (t0), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95% CI 0.96 to 1.56) or agility (ARR 1.33; 95% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t0 to t2), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare.

CONCLUSIONS: Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.

Key Words

medically uninsured health status Medicare 

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Copyright information

© the Society of General Internal Medicine 2006

Authors and Affiliations

  • David W. Baker
    • 1
    • 2
  • Joseph Feinglass
    • 1
    • 2
  • Ramon Durazo-Arvizu
    • 3
  • Whitney P. Witt
    • 1
    • 4
  • Joseph J. Sudano
    • 5
  • Jason A. Thompson
    • 1
  1. 1.Division of General Internal Medicine, Department of Medicine Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Institute for Healthcare Studies, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Department of Preventive Medicine and EpidemiologyLoyola University Chicago-Stritch School of MedicineChicagoUSA
  4. 4.Buehler Center on Aging, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  5. 5.Center for Health Care Research and PolicyCase Western Reserve University at MetroHealth Medical CenterClevelandUSA

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