Younger Medicare Patients Face More Access, Cost Problems

The 8 million younger Medicare beneficiaries with permanent disabilities—including serious and persistent mental illness—face more difficulty affording medications and accessing care than do the majority of Medicare beneficiaries—those who qualify because they are aged 65 or older, according to a recent survey.

An analysis of a 2008 nationally representative survey of Medicare participants published in the August 12 Health Affairs found that because of cost and access difficulties, beneficiaries under age 65—those who qualify for Medicare coverage through the Social Security Disability Insurance (SSDI) program—reported more adverse health consequences, according to the authors.

The report, by Juliette Cubanski, associate director of the Medicare Policy Project at the Kaiser Family Foundation (KFF), and Patricia Neuman, a vice president of KFF, identified problems more specific to people with mental illness. About one-third of the 8.9 million people receiving SSDI in 2009 had a diagnosed psychiatric illness, according to the Social Security Administration. Younger beneficiaries qualify for Medicare coverage under SSDI if their disability leaves them unable “to engage in substantial gainful activity because of any medically determinable permanent physical or mental impairment,” according to the program's rules.

The challenges faced by these younger Medicare beneficiaries include higher rates of multiple chronic illnesses than other Medicare beneficiaries. Half of nonelderly beneficiaries reported five or more chronic health conditions, while only about one-fourth of the elderly Medicare recipients had this many chronic conditions.

The differences in access to care and costs of care between the two Medicare populations start with differences in supplemental “Medigap” insurance, which covers most of Medicare's out-of-pocket costs. According to the survey data, nearly 1 in 4 nonelderly Medicare beneficiaries lacks supplemental coverage—twice the proportion in the older group.

In one area critical to people with serious mental illness—prescription-drug coverage—disabled nonelderly Medicare recipients appeared to have somewhat better coverage than older Medicare beneficiaries. In 2008, 88 percent of nonelderly disabled beneficiaries had prescription drug coverage, compared with 84 percent of the elderly ones.

The medical care needs of younger Medicare beneficiaries also appeared significant. Nonelderly disabled beneficiaries reported higher utilization rates of inpatient hospitalization, as well as more emergency room and office or clinic visits. In addition, a higher share of nonelderly beneficiaries reported receiving mental health care or counseling, likely due to higher reported rates of mental health conditions compared with elderly Medicare beneficiaries, the authors noted.