title: Examining access to care for younger vs. older dual-eligible adults living in the community.
abstract: Recent state dual-eligible (Medicare and Medicaid) payment reform demonstrations have included groups of both working-age and older adults, but relatively little is known about how access to care varies between these two populations.
  
  
  
  To examine access to a usual source of care for younger and older dual-eligible adults, to analyze whether timely access to several types of care differed in these two populations, and to understand some of the underlying reasons for delayed care among younger and older dual-eligibles.
  
  
  
  Using observations pooled across calendar years 2003-2012 of the Medical Expenditure Panel Survey, this study conducted descriptive and multivariate analyses to examine access to care measures.
  
  
  
  Younger dual-eligible adults were more likely to encounter problems with accessing medical care, dental care, and prescription medications than older dual-eligible adults. Both groups of dual-eligible adults reported that a lack of affordability, gaps in existing insurance coverage, and difficulty in getting to a provider's office were the most common reasons for delayed access to care.
  
  
  
  A lack of affordability for medical care, dental care, and prescription medications suggests that high co-payments and cost sharing for some services may be deterring access to needed care. Younger dual-eligibles were more likely to encounter service coverage gaps than older dual-eligibles. States should monitor Medicare-Medicaid plans to confirm they have adequate provider networks.
authors.affiliation: Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA. Electronic address: ggimm@gmu.edu.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gimm
authors.affiliation: Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Blodgett
authors.affiliation: Department of Statistics, University of Houston - Clear Lake, Houston, TX 77058, USA.
authors.forename: Preeti
authors.initials: P
authors.lastname: Zanwar
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003729:Dental Care; D006233:Persons with Disabilities; D004608:Eligibility Determination; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006296:Health Services; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D055553:Prescription Drugs; D014186:Transportation; D014481:United States; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: Access to care; Disability; Dual-eligible