Younger Medicare Beneficiaries Report More Issues with Care Access, Costs

April 13, 2023 - Medicare beneficiaries under age 65 reported more cost concerns, worse access to care, and lower care satisfaction compared to older beneficiaries, indicating that the program may not successfully meet the needs of beneficiaries with disabilities, a study published in Health Affairs found.

Although Medicare policy discussions tend to focus on people 65 and older, 13 percent or 8 million beneficiaries are younger than 65. The majority (79 percent) of these beneficiaries are between 45 and 64, while 21 percent are younger than 45. Adults under age 65 generally qualify for Medicare if they have received Social Security Disability Insurance (SSDI) for 24 months.

Researchers from the Kaiser Family Foundation (KFF) used data from the Medicare Current Beneficiary Survey 2019 Survey File to assess measures of access to care, cost concerns, and satisfaction among beneficiaries younger than 65 and those ages 65 and older in traditional Medicare and Medicare Advantage.

The study sample represented 53.6 million Medicare beneficiaries in 2019: 46.5 million beneficiaries aged 65 and older and 7 million beneficiaries younger than 65 who were eligible for Medicare due to a long-term disability. Around 31 million beneficiaries were enrolled in traditional Medicare and 22 million were enrolled in Medicare Advantage.

Younger beneficiaries were more likely to be Black or Hispanic and have an income of less than $20,000 compared to older beneficiaries. In addition, a larger share of younger beneficiaries were in fair or poor health, had six or more chronic conditions, three or more functional limitations, and a cognitive or mental impairment.

Younger beneficiaries were more likely to report problems with accessing care, cost concerns, and lower satisfaction levels.

Specifically, 18 percent of younger beneficiaries reported trouble accessing healthcare in the past year compared to 6 percent of older beneficiaries and 15 percent of younger adults reported having a problem that a doctor should see but not getting treatment for it compared to 6 percent of older adults. Younger adults were also more likely to be prescribed medications they did not receive (9 percent versus 5 percent).

Almost a quarter of younger beneficiaries said they were unsatisfied with their out-of-pocket spending for medical care compared to 15 percent of older beneficiaries. Similarly, 23 percent of beneficiaries under 65 reported a care delay due to costs, while just 8 percent of beneficiaries ages 65 and older said the same.

Ten percent of younger beneficiaries reported being unsatisfied with the quality of their medical care compared to 3 percent of older beneficiaries.

Results were similar in Medicare Advantage, with beneficiaries under 65 reporting more issues with care access, costs, and satisfaction. As Medicare Advantage enrollment among younger beneficiaries increases, this finding raises potential concerns.

While Medicare Advantage plans offer supplemental benefits that could meet certain care needs for this population, provider network and prior authorization requirements may impact care access and satisfaction.

Younger beneficiaries with and without supplemental coverage generally reported more problems than older beneficiaries. However, among younger beneficiaries in traditional Medicare, those without supplemental coverage were more likely to report cost concerns.

One million younger beneficiaries did not have supplemental coverage in traditional Medicare, while 3.3 million did. Around half (51 percent) of the beneficiaries without supplemental coverage reported being unsatisfied with out-of-pocket spending for care compared to 15 percent of those with supplemental coverage.

Similarly, 40 percent of beneficiaries without supplemental coverage reported a care delay due to costs, while only 16 percent of those with supplemental coverage did.

Policymakers could address this disparity by broadening eligibility for the Medicare Savings Programs to allow more lower-income beneficiaries access to premium and cost-sharing assistance under Medicaid. Expanding Medigap coverage to people under 65 with disabilities could also help improve care experiences.

The findings question whether the current Medicare program is equipped to meet the physical and mental health needs of beneficiaries with disabilities. Policymakers should focus on improving Medicare coverage of substance use disorders and mental healthcare to address this population’s needs better.