Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With and Without Food Insecurity.

Autor: Park S; Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea. sungchul_park@korea.ac.kr.; BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea. sungchul_park@korea.ac.kr., Berkowitz SA; Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Oct; Vol. 39 (13), pp. 2407-2414. Date of Electronic Publication: 2024 May 16.
DOI: 10.1007/s11606-024-08798-4
Abstrakt: Background: Compared to traditional Medicare (TM), Medicare Advantage (MA) plans impose out-of-pocket cost limits and offer extra benefits, potentially providing financial relief for MA enrollees, especially for those with food insecurity.
Objective: To examine whether the prevalence of food insecurity differs between TM and MA enrollees at baseline and then examine whether MA enrollment in a baseline year is associated with less financial hardships in the following year, relative to TM enrollment, especially for those experiencing food insecurity.
Design: We conducted a retrospective longitudinal cohort study.
Participants: Our analysis included 2807 Medicare beneficiaries (weighted sample size, 23,963,947) who maintained continuous enrollment in either TM or MA in both 2020 and 2021 from the Medical Expenditure Panel Survey.
Main Measures: We assessed outcomes related to financial hardships in health care and non-health care domains (measured in 2021). Our primary independent variables were food insecurity and MA enrollment (measured in 2020).
Results: The point estimate of food insecurity prevalence was greater among MA enrollees than TM enrollees, but the difference was not statistically significant (1.1 percentage points [95% CI, - 1.0, 3.4]). Furthermore, there is evidence that compared to TM enrollment, MA enrollment did not mitigate the risk of financial hardship, particularly for food-insecure enrollees. Rather, food-secure MA enrollees faced greater financial hardship in the following year than food-secure TM enrollees (11.2% [8.9-13.6] and 7.6% [6.9-8.3] for problems paying medical bills and 5.5% [4.6-6.4] and 2.8% [2.1-3.6] for paying medical bills over time). Moreover, the point estimate of financial hardship was higher among food-insecure MA enrollees than food-insecure TM enrollees (21.5% [5.4-37.5] and 11.2% [4.1-18.4] and 23.7% [9.6-37.9] and 6.9% [0.5-13.3]) despite the lack of statistical significance.
Conclusion: These findings suggest that the promise of financial protection offered by MA plans has not been fully realized, particularly for those with food insecurity.
(© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Databáze: MEDLINE
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