Overall Satisfaction with Medicare is High, But Beneficiaries Under Age 65 With Disabilities Experience More Insurance Problems Than Older Beneficiaries


Whilst most of the people with Medicare are adults age 65 or older, Medicare additionally covers tens of millions of more youthful individuals who qualify for Medicare in keeping with having a long-term disability, or prognosis with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, sometimes called Lou Gehrig’s illness). In 2022, 7.7 million other folks below age 65 with disabilities have been lined through Medicare, representing 12% of all Medicare beneficiaries. More youthful beneficiaries who qualify for Medicare on account of incapacity are much more likely than those that qualify in keeping with age to have lower incomes and education levels, to be Black or Hispanic, and to be in worse health.

Medicare covers the similar advantages for other folks of every age, without reference to how they certified for Medicare, and Medicare protection choices and fiscal help systems are in most cases the similar – the primary exception being that folks below age 65 with disabilities don’t have a assured factor proper to buy Medigap supplemental insurance policies. Alternatively, in all probability associated with their other pathways to Medicare eligibility and as the program used to be originally designed to cover older adults, with protection for more youthful other folks with disabilities added later, Medicare in most cases does not work as well for other folks below age 65 with disabilities. This conclusion is in keeping with KFF research of surveys courting again to 2008 however now not newer than 2019. In step with earlier research, beneficiaries below age 65 with disabilities have reported worse get right of entry to to care, extra price considerations, and decrease pleasure with care than the ones age 65 or older.

To get a extra present working out of ways Medicare is operating for older adults and more youthful other folks with disabilities, this temporary analyzes knowledge from the 2023 KFF Survey of Consumer Experiences with Health Insurance, a nationally consultant survey of three,605 U.S. adults with medical insurance. This temporary focuses particularly at the 885 adults with Medicare, together with 165 adults below the age of 65 with disabilities.

This research supplies a window into the demanding situations going through other folks with disabilities as they navigate the medical insurance gadget through specializing in the reports of more youthful adults on Medicare who qualify for this system because of having a long-term incapacity. The research highlights the techniques by which beneficiaries below age 65 with disabilities is also much less neatly served through the Medicare program than older beneficiaries. (Whilst other folks with disabilities also are integrated a few of the inhabitants of Medicare beneficiaries age 65 or older, the survey pattern is inadequate to concentrate on this staff particularly.) Other people with disabilities who’re lined through personal insurance coverage or Medicaid are prone to face an identical demanding situations the usage of their protection. Insights from this research may just lend a hand to tell efforts to make stronger the Medicare program, specifically for more youthful adults with disabilities.

Key Takeaways

  • Total, other folks with Medicare are more satisfied with their medical insurance protection than adults with different varieties of insurance coverage, however amongst other folks with Medicare, the ones below age 65 with disabilities are much less most likely than the ones age 65 or older to present sure rankings to the whole efficiency in their insurance policy (79% vs. 92%) and a few options of it, similar to the standard and availability of suppliers.
  • Total, a majority of Medicare beneficiaries below age 65 with disabilities say they skilled an issue with their medical insurance within the closing yr (70%), in comparison to part (49%) of the ones age 65 or older. This features a greater percentage of the ones below age 65 with disabilities who say they skilled denials or delays in getting prior approval (27% vs. 9%) or insurance coverage now not paying for care they won that they idea used to be lined (24% vs. 8%).
  • A slightly small percentage of all Medicare beneficiaries who mentioned they’d an issue with medical insurance previously yr reported problem having access to care as a right away results of those issues, however get right of entry to issues have been much more likely to be reported through Medicare beneficiaries below age 65 with disabilities than the ones 65 or older. A minimum of one in 5 Medicare beneficiaries below age 65 with disabilities who reported issues say they have been not able to obtain really useful remedy (24%) or skilled important delays in receiving hospital treatment or remedy (21%), in comparison to very small stocks of the ones 65 or older who mentioned the similar (6% for each).
  • Medicare beneficiaries below 65 with disabilities have been much more likely to enjoy problem with the medical insurance enrollment procedure and evaluating insurance coverage choices in comparison to beneficiaries age 65 or older, together with understanding if their revenue qualifies them for monetary help (30% vs. 11%).
  • Price considerations associated with insurance coverage are a subject matter for Medicare beneficiaries of every age, specifically in the case of per 30 days premiums and out-of-pocket prices for prescribed drugs, however a bigger percentage of other folks with Medicare below age 65 with disabilities than the ones age 65 or older record sure issues. Multiple in 3 other folks with Medicare below age 65 with disabilities record they’d an issue paying a scientific invoice previously twelve months (35%), in comparison to one in ten (9%) of the ones 65 or older. Other people with Medicare below age 65 with disabilities have been additionally much more likely to record delaying or going with out explicit well being care services and products because of price, similar to dental care (42% vs. 24%), prescribed drugs (18% vs. 10%), and physician visits (14% vs. 4%).
  • About part of other folks with Medicare below age 65 with disabilities self-report truthful or deficient bodily well being, in comparison to 19% of the ones age 65 or older, since, through definition, other folks below age 65 qualify for Medicare in keeping with having a long-term incapacity. The upper fee of poorer self-reported well being amongst beneficiaries below age 65 may just give a contribution to a better fee of medical insurance issues.
  • 3 in 10 other folks with Medicare below age 65 with disabilities self-report truthful or deficient psychological well being standing, in comparison to 1 in 10 (9%) of the ones age 65 or older, and a bigger percentage additionally record issues associated with psychological well being care availability and get right of entry to, together with reporting that there used to be a psychological well being therapist or remedy they wanted that wasn’t lined through insurance coverage (27% vs. 7%), and being not able to obtain psychological well being services and products or medicine previously yr they idea they wanted (18% vs. 5%).

Delight with Protection

Other people with Medicare are more satisfied with their medical insurance protection than the ones with employer-sponsored insurance coverage, Market protection, and Medicaid. And whilst majorities of other folks with Medicare of every age fee Medicare undoubtedly, the ones below age 65 with disabilities are much less most likely than older beneficiaries to present sure rankings to Medicare and a few options of it. Whilst 92% of beneficiaries age 65 or older fee Medicare’s efficiency undoubtedly, a smaller percentage, however nonetheless a majority (79%) of Medicare beneficiaries below 65 with disabilities rated Medicare’s efficiency as superb or just right (Determine 1). A smaller percentage of Medicare beneficiaries below 65 with disabilities than the ones 65 or older rated each the supply and the standard of medical doctors, hospitals, and different scientific suppliers as superb or just right.

Issues of Well being Insurance coverage

Total, a somewhat smaller share of other folks with Medicare than other folks with employer-sponsored insurance coverage, Market protection, or Medicaid record experiencing any issues of their medical insurance previously twelve months (51% in comparison to 60%, 56%, and 58%, respectively). Amongst Medicare beneficiaries, a majority (70%) of the ones below age 65 with disabilities say they skilled any downside, in comparison to part (49%) of the ones 65 or older. As a result of a bigger percentage of beneficiaries below age 65 with disabilities record that they’re in truthful or deficient bodily and psychological well being and feature serious persistent stipulations in comparison to beneficiaries age 65 or older (Appendix Figure 1), the ones below age 65 with disabilities is also much more likely to have more than one encounters with the well being care gadget all the way through the yr and stumble upon explicit issues once they do.

As an example, greater than one-fourth (27%) of Medicare beneficiaries below age 65 with disabilities mentioned their medical insurance denied or behind schedule prior popularity of a remedy, provider, consult with, or drug prior to they won it, in comparison to just below one in 10 (9%) beneficiaries 65 or older (Determine 2). In a similar fashion, a bigger percentage of beneficiaries below 65 with disabilities than the ones 65 or older reported that their insurance coverage didn’t pay for care they won that they idea used to be lined (24% vs. 8%). However one downside, specifically, used to be reported through a an identical percentage of each teams: 34% of beneficiaries below age 65 with disabilities and 26% of the ones age 65 or older reported that insurance coverage didn’t duvet or required a prime copay for a prescription drug.

To the level that folks below 65 with disabilities are searching for hospital treatment extra continuously, or searching for extra specialised hospital treatment, than the ones age 65 or older, insurance coverage issues might be exacerbated for the ones below age 65 who’re enrolled in Medicare Merit plans, which could have restricted networks of medical doctors and hospitals and can impose prior authorization requirements on Medicare-covered services and products. (Because of pattern measurement boundaries, this research through age staff isn’t in a position to be stratified through enrollment in conventional Medicare and Medicare Merit.)

Studies with Enrollment and Evaluating Choices

Medicare beneficiaries below age 65 with disabilities are much more likely to enjoy problem with the Medicare enrollment procedure and evaluating Medicare protection choices in comparison to beneficiaries age 65 or older. The share of beneficiaries below 65 with disabilities who had problem enrolling in Medicare (26%) or understanding if their revenue certified them for monetary help (30%) used to be considerably greater than amongst the ones 65 or older (10% and 11%, respectively) (Determine 3). In a similar fashion, just about 1 / 4 of the ones below 65 with disabilities reported that it used to be quite or very tough to seek out insurance coverage to satisfy their wishes (23%), in comparison to 14% of the ones age 65 or older. This problem may just mirror the good selection of coverage options that Medicare beneficiaries face, together with the selection of whether or not to sign up for conventional Medicare or Medicare Merit, and opting for amongst Medicare Merit and Section D drug plan choices. It may also mirror difficulties amongst low-income beneficiaries associated with enrolling in Medicaid, the Medicare Financial savings Methods, or the Section D Low-Source of revenue Subsidy program for extra advantages and fiscal help.

Working out of Insurance coverage

Total, a smaller share of people with Medicare than those with other types of insurance record problem working out more than a few facets of medical insurance, however amongst the ones with Medicare, a bigger percentage of other folks below 65 with disabilities than the ones age 65 or older say they in finding it obscure more than a few facets of medical insurance. Particularly, Medicare beneficiaries below 65 with disabilities are much more likely to mention they have got problem working out explicit insurance coverage phrases similar to “deductible” and “prior authorization” (34% vs. 17%), how a lot they’ll need to pay out-of-pocket once they use well being care (32% vs. 18%), insurance coverage statements outlining whether or not care shall be lined and what kind of insurance coverage pays (31% vs. 17%), and how one can in finding knowledge on which suppliers are lined of their insurance coverage community (28% vs. 13%) (Determine 4).

Penalties of Issues of Well being Insurance coverage

Total, a relatively small share of Medicare beneficiaries who mentioned they’d any downside with medical insurance previously twelve months reported delays getting (9%) or being not able to get hospital treatment (9%) as a right away results of those issues, however those get right of entry to issues have been much more likely to be reported through Medicare beneficiaries below age 65 with disabilities than the ones 65 or older. A number of the 70% of other folks below age 65 with disabilities with Medicare who mentioned they’d an issue with insurance coverage previously twelve months, just about one fourth (24%) reported they have been not able to obtain care previously twelve months as a right away results of those issues. Through comparability, a few of the 49% of other folks age 65 or older on Medicare, 6% reported being not able to obtain care in consequence (Determine 5). In a similar fashion, amongst Medicare beneficiaries who had an issue with their insurance coverage previously yr, a miles greater percentage of the ones below age 65 with disabilities than the ones age 65 or older reported delays in receiving care previously twelve months because of medical insurance issues (21% vs. 6%).

Studies Associated with Psychological Well being Care

Other people with Medicare below age 65 with disabilities are much more likely than the ones age 65 or older to record issues associated with psychological well being care availability and get right of entry to. 3 in 10 (30%) of Medicare beneficiaries below age 65 with disabilities self-report truthful or deficient psychological well being standing in comparison to 9% of the ones age 65 or older, making it much more likely that they might search psychological well being remedy (Appendix Figure 1). This generally is a consider larger dissatisfaction amongst other folks with Medicare below age 65 with disabilities in the case of each the supply and high quality of psychological well being therapists and pros lined through their insurance coverage: the ones below 65 with disabilities are much more likely than the ones 65 or older to fee insurance coverage as truthful or deficient in the case of the supply (37% vs. 20%) and the standard (35% vs. 16%) of psychological well being suppliers lined through insurance coverage (Determine 6).

Moreover, greater than 1 / 4 (27%) of Medicare beneficiaries below 65 with disabilities reported there used to be a psychological well being therapist or remedy they wanted that wasn’t lined through insurance coverage, and just about 1 in 5 (18%) mentioned they have been not able to obtain psychological well being services and products or medicine previously yr they idea they wanted. Considerably smaller stocks of beneficiaries age 65 or older reported those issues (7% and 5%, respectively). (Because of pattern measurement restrictions, this research through age staff isn’t in a position to be stratified through psychological well being standing or restricted to those that fee their psychological well being as truthful or deficient.)

Affordability Considerations

Price considerations associated with insurance coverage are a subject matter for Medicare beneficiaries of every age, specifically in the case of per 30 days premiums and out-of-pocket prices for prescribed drugs. Total, round one-fourth of Medicare beneficiaries gave their insurance coverage a “truthful” or “deficient” ranking on those measures. Alternatively, some price considerations are skilled through a bigger percentage of other folks with Medicare below age 65 with disabilities than the ones age 65 or older, which is most likely associated with a considerably larger proportion of the ones below age 65 with disabilities having earning under 200% of poverty in comparison to the ones age 65 or older (77% vs. 44%) (Appendix Figure 1). As an example, 36% of the ones below 65 with disabilities gave a adverse ranking to their insurance coverage in the case of the out-of-pocket price they have got to pay to peer a health care provider, in comparison to 19% of the ones 65 or older (Determine 7). In a similar fashion, over one-third (35%) of other folks below age 65 with disabilities mentioned that previously yr they’d issues paying or have been not able to pay any scientific expenses, in comparison to one in 10 (9%) of the ones age 65 or older.

Total, a small percentage of Medicare beneficiaries record delaying or going with out physician’s visits or prescribed drugs previously yr because of price, however those percentages building up quite in the case of services and products that Medicare doesn’t duvet, particularly dental care. Just about one fourth (24%) of Medicare beneficiaries age 65 or older say they behind schedule or went with out dental care previously yr because of price, and this percentage rises to 42% amongst the ones below age 65 with disabilities (Determine 8). In a similar fashion, greater stocks of other folks with Medicare below age 65 with disabilities than the ones age 65 or older say they behind schedule or went with out imaginative and prescient services and products, which might be additionally now not lined through Medicare (25% vs. 13%), prescribed drugs (18% vs. 10%), and physician’s administrative center visits (14% vs. 4%) previously yr on account of price.

Conclusion

Effects from the 2023 KFF Survey of Consumer Experiences with Health Insurance display other folks with Medicare are more satisfied with their medical insurance protection than the ones with different varieties of insurance coverage, however amongst other folks with Medicare, the ones below age 65 with disabilities are much less most likely than the ones age 65 or older to fee Medicare undoubtedly in the case of the whole efficiency in their insurance coverage and more than a few options of it. Medicare beneficiaries below age 65 with disabilities are much more likely than the ones age 65 or older to enjoy get right of entry to and price issues when the usage of their insurance coverage.

As a result of a bigger percentage of other folks with Medicare below age 65 with disabilities record that they’re in truthful or deficient bodily and psychological well being and feature serious persistent stipulations in comparison to other folks age 65 or older, the ones below age 65 with disabilities is also much more likely to have more than one encounters with the well being care gadget all the way through the yr and stumble upon issues once they do. And with a better percentage of beneficiaries below age 65 with disabilities than the ones 65 or older having slightly low earning, other folks below age 65 are much more likely to have issues affording well being care prices.

Addressing spaces of specific fear for beneficiaries below age 65 with disabilities – together with insurance policies that cope with problems associated with supplier get right of entry to and availability, fortify the method of evaluating plans and enrolling, beef up working out of more than a few options of Medicare, together with out-of-pocket prices and supplier community restrictions (for Medicare Merit plans), and fortify get right of entry to to monetary help systems that lend a hand with affordability – may just result in higher reports with Medicare for beneficiaries below age 65 with disabilities.

This paintings used to be supported partly through the Robert Wooden Johnson Basis. KFF maintains complete editorial keep watch over over all of its coverage research, polling, and journalism actions.

This KFF Survey of Shopper Studies with Well being Insurance coverage used to be designed and analyzed through researchers at KFF. The survey used to be designed to achieve a consultant pattern of insured adults within the U.S. The survey used to be performed February 21–March 14, 2023, on-line and through phone amongst a nationally consultant pattern of three,605 U.S. adults who’ve employer backed insurance coverage (978), Medicaid (815), Medicare (885), Market plans (880), or a Army plan (47). The Medicare pattern contains 720 respondents age 65 or older and 165 respondents below age 65 with disabilities. The margin of sampling error is plus or minus 2 proportion issues for the overall pattern, and plus or minus 4 proportion issues for adults with Medicare. The margin of sampling error is plus or minus 11 proportion issues for adults below the age of 65 with Medicare and plus or minus 5 proportion issues for adults age 65 or older with Medicare. For effects in keeping with different subgroups, the margin of sampling error is also upper.

The pattern contains 2,595 insured adults reached during the SSRS Opinion Panel both on-line or over the telephone (n=75 in Spanish). Any other 504 respondents have been reached on-line during the Ipsos Wisdom Panel. Any other 289 (n=10 in Spanish) interviews have been performed from a random digit dial (RDD) of pay as you go mobile phone numbers (n=190) and landline phone numbers (n=99). An extra 217 respondents have been reached through calling again respondents who mentioned they have been insured in earlier KFF probability-based polls.

Respondents have been weighted one after the other to check every staff’s demographics the usage of knowledge from the 2021 American Neighborhood Survey (ACS). Weighting parameters integrated gender, age, schooling, race/ethnicity, and area.

For complete main points at the survey technique, see the Technique tab of the KFF Survey of Consumer Experiences with Health Insurance.



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