The study measures the positive impact of Medicare on low-income adults

Medicare eligibility and enrollment are linked to lower percentages of low-income adults who delay or avoid health care because of cost, and the percentage who worry about or have trouble paying medical bills, according to a new study released in October. . 4 in an open access journal PLOS Medicine Rishi Vadhera, from Beth Israel Deaconess Medical Center and Harvard Medical School, USA, and colleagues.

In the United States, low-income adults are more likely to experience deprivation health insurance, face barriers to accessing health care and disproportionately experience financial hardship due to health care costs compared to higher-income adults. The Medicare program provides health insurance for more than 50 million elderly people in the United States.

In the new study, researchers used cross-sectional data from the 2019 US National Health Survey on 1.66 million low-income adults age 64 — just below the Medicare eligibility threshold at age 65 — and 1.49 million adults, eligible for Medicare, age 66, with similar baseline characteristics other than age and Medicare eligibility. The study also included a higher-income cohort of 2.11 million adults aged 64 and 2.17 million adults aged 66.

For low-income adults, becoming eligible for Medicare at age 65 was associated with improvements in several areas. Among low-income 64-year-olds, 14.7% delayed benefits and 15.5% avoided benefits because of costs, while among low-income 66-year-olds, only 6.2% avoided benefits and 5.9% delayed benefits because of costs , a decrease of 8.5% (95% CI: −14.7% to −2.4%, P = 0.007) and 9.6% (−15.9% to −3.2%, P = 0.003 ).

Similarly, there was a significant decrease in financial burden indicators; at age 64, 66.5% of low-income adults were worried about medical bills, and 33.9% had difficulty paying medical bills. At age 66, 51.1% were worried and 20.6% had difficulty paying medical bills, a decrease of 15.4% (-25.4% to -5.4%, P=0.003) and 13.3% (-23.0% to -3.6%, P=0.007). Results were more modest and less consistent among adults with higher incomes. Medicare was not associated with changes in the percentage of low- or high-income adults who experienced cost-related barriers to using medications.

“As the U.S. debate continues over whether to lower the Medicare eligibility age, politicians the potential implications of this for access and affordability of health care for low-income adults, and more broadly, health equity, should be considered,” the authors say.

Wadhera adds, “More than 40% of American adults under the age of 65 are either uninsured or underinsured. Most Americans do not become eligible for Medicare until age 65, and our results suggest that this transition is associated with significant improvements in health care access, affordability and reduced financial burden for low-income adults and to a lesser extent for higher-income adults. As policymakers debate whether to expand Medicare, our study provides evidence that lowering the Medicare eligibility age can improve health equity in the US.”