Abstract
BACKGROUND: Medicare coverage at age 65 improves access to and use of care and alleviates financial hardship for the general population. However, less is known whether the effects differ between individuals without and with functional disability. OBJECTIVES: To examine the effects of Medicare eligibility at age 65 on health insurance coverage, financial burden of care, and access to care among individuals without and with functional disability. DESIGN: We used a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65 and compares individuals just before and after age 65. PARTICIPANTS: Our analysis included 19,876 individuals (aged 59-71) without functional disability and 8376 individuals with functional disability from the 2014-2021 Medical Expenditure Panel Survey. MAIN MEASURES: We assessed health insurance coverage, financial burden of care, and access to care. RESULTS: Medicare eligibility led to increases in any and Medicare coverage for both groups, but those with functional disability had a decrease in Medicaid coverage by - 2.6 percentage points. Medicare eligibility resulted in lower financial burden of care for both groups, but the effects were greater among those with functional disability (- $578 vs. - $344 for out-of-pocket spending, - 3.7 vs. - 4.9 percentage points for cost-sharing, and - 2.5 vs. - 0.8 percentage points for paying medical bills over time). Although Medicare eligibility led to a decrease in delayed medical care among those without functional disability (- 2.1 percentage points), no change was observed among those with functional disability. Notably, access to care remained limited among those with functional disability after obtaining Medicare eligibility (8.6% and 3.9% for being unable to get medical care and experiencing delay in getting medical care). CONCLUSION: Medicare coverage can reduce financial hardship, especially for individuals with functional disability. However, there is a need to develop policies that ensure equitable access to care for those with functional disability.