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Medicare Strands Disabled More than Elderly, Study Says

September 24 2010 | by

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Some things just get better with age – and it seems Medicare may be one of them. A recent report by the Kaiser Family Foundation says Medicare is not working as well for its eight million disabled beneficiaries under age 65 as it is for its elderly beneficiaries.

The study found that younger Medicare recipients with disabilities are much more likely than seniors in the program to report problems accessing and paying for medical services. In fact, half of nonelderly disabled beneficiaries surveyed report having trouble paying for health care –- nearly three times the rate reported by seniors (50 percent vs. 18 percent).

One in three of the younger, disabled respondents say they actually have spent less money on basic needs like food and heat, so they would have enough to pay for health care. By contrast, only one in 11 elderly respondents had to resort to such measures.

The study, based on a national random-sample survey of people on Medicare in 2008 and published in the September 2010 issue of Health Affairs, also revealed that nonelderly disabled Medicare beneficiaries were more likely to be in poorer health, suffer from multiple chronic health conditions, battle more pain and depression and bring home smaller paychecks.

“People with disabilities have diverse and sometimes extensive and complex needs,” says Jeffrey Crowley, White House senior advisor on disability policy and director of the Office of National AIDS Policy. “One of the things important to note is just how much we don’t really know about what is going on with people with disabilities and Medicare.”

But this report is an important step toward understanding, according to Crowley, who served on a panel of experts to discuss the Kaiser Family Foundation report at a recent forum about Medicare and health care reform in Washington, D.C.

Other key findings from the report:
• Nonelderly disabled beneficiaries are three times more likely than elderly recipients to report having a problem finding a doctor who accepts Medicare
• Fifteen percent of younger disabled beneficiaries also report difficulty finding a doctor who even understands their disability or how to treat it
• Nearly half (46 percent) of nonelderly disabled say they have delayed getting a health care service – or did not get it at all – because of cost. This is compared to 16 percent of seniors
• More than half of those nonelderly disabled (54 percent) who reported delaying or canceling care said one of the effects of this decision is significant physical pain
• More nonelderly disabled than elderly say they delayed or skipped getting medication because it wasn’t covered under their Medicare Part D drug plan
• One in three nonelderly disabled beneficiaries went without health insurance for at least part of a two-year waiting period before qualifying for Medicare

“Other research has shown that when people lack health insurance, they are more likely to delay or forego needed care, which could lead to more serious problems that are more difficult and costly to treat,” says Juliette Cubanski, associate director of the Medicare Policy Project at the Kaiser Family Foundation and co-author of the study. “In this way, the 24-month waiting period represents a potentially harmful barrier to health care for people with disabilities.”

So the younger set of Medicare beneficiaries are paying a hefty price, whether it’s pain caused by worsening (and untreated) conditions, stress brought on by a lack of care or the funds to pay for it or gaps in the system that can sometimes leave them high and dry.

“Some of the biggest gaps for people with disabilities relate to long-term care,” says Crowley. “People for whom it’s not (necessarily) about their medical needs – but they might need help with activities of daily living. They might need help getting out of bed, getting dressed, managing their home, things like that. And one of the challenges for policymakers is that it just seems like such a big challenge, how do we take it on?”

According to Crowley, the Patient Protection and Affordable Care Act does take on that challenge and helps to close gaps in coverage. Some ways it can help people with disabilities on Medicare include:

• alleviating out-of-pocket spending burdens by phasing in coverage for the Part D coverage gap and by eliminating cost sharing for certain preventive services
• expanding access to health insurance through high-risk pools (beginning this year) and through Medicaid or insurance exchanges (beginning in 2014)
• expanding home- and community-based care

“There are (still) some challenges, but as we go forward, the Affordable Care Act provides a platform for addressing a lot of the challenges that we have,” Crowley says.

The Kaiser Family Foundation also launched a website dedicated to explaining the health care law and tracking its progress. It includes a timeline that shows how and when specific provisions of the law will be put in place over the next several years. The site offers information on Medicare, Medicaid, prescription drugs, long-term care and other categories critical to people with disabilities. Visit http://healthreform.kff.org/. It’s worth the trip.

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