title: Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults.
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.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. awillin2@jhu.edu.
authors.forename: Amber
authors.identifier: 0000-0002-8016-7243
authors.initials: A
authors.lastname: Willink
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Davis
authors.affiliation: New York Academy of Medicine, New York, NY, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Schoen
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wolff
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction; D003695:Delivery of Health Care / Q000191:economics*; D006233:Persons with Disabilities; D004608:Eligibility Determination; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States
keywords: Cognitive impairment; Disability; Health care costs; Medicaid; Medicare