Access to Care for Older vs. Younger Dual-Eligible Adults in the Community
Population Studied: We included older dual-eligible adults (65-85 years) and younger adults (18-64 years) in our sample (weighted N=2,889,263). Most dual-eligible adults (85 percent) had a self-reported disability, which we broadly defined as having any type of physical, cognitive, or work limitation.
Principal Findings: Younger dual-eligible adults were less likely to have a usual source of care provider (OR = 0.51, p<.05), and were more likely to encounter delays in getting needed medical care (OR = 2.18, p<.01). Younger dual-eligibles also had twice the odds of reporting delays with needed dental care (OR = 1.86, p<.05) and prescription medications (OR = 1.91, p<01). Lack of affordability and gaps in existing service coverage were the most prevalent reasons for delayed medical care, followed by problems getting to a provider’s office.
Conclusions: Younger dual-eligible adults (18-64 years) were more likely to encounter problems with having a usual source of care, and timely access to needed medical care, dental care, or prescription medications, compared to older dual-eligible adults (65-85 years). Both groups reported that a lack of affordability, gaps in existing Medicare or Medicaid insurance coverage, and difficulty in getting to a provider’s office were the most common reasons for delaying to skipping care. A lack of affordability for medical care, dental care, and prescription medications suggests that high co-payments and cost-sharing for some services as well as formulary gaps may be deterring access to care for dual-eligible adults with disabilities. States should monitor individual Medicare-Medicaid plans to confirm the adequacy of provider networks and affordability of services.
Keywords: access to care, dual-eligible, usual source of care