Supplemental coverage decisions among near Medicare eligible adults with chronic disease

This study investigates the impact of inadequate health insurance coverage (underinsurance) on individual health outcomes. Because a respondent’s health status can influence their decision to obtain health insurance, negative binomial regression discontinuity analysis that exploits public pension eligibility and Medicare eligibility thresholds will be utilized. The primary outcome variables are physician visits and the cost of the associated visit. We focus on four measures: the number of routine hospital visits, the number of emergency room visits, the cost of the respondent’s routine hospital visits, and the cost of the respondent’s emergency room visits. Individual controls, such age, gender, race/ethnicity, educational attainment, household income, geographic region, and survey year, will control for socioeconomic differences between respondents. Our primary study population consists of respondents who have been diagnosed with coronary heart disease and stroke (CHDS) aged 60 to 70. Patients with CHDS are an excellent study population because they require continuous monitoring, expensive equipment, and specialist care. Initial findings suggest that upon reaching the Medicare eligibility threshold, those individuals with some form of supplemental coverage have lower healthcare expenditures and utilization than individuals without supplemental coverage. Substantial disparities exists across racial and income groups. Dual eligible (recipients of both Medicaid and Medicare) were found to have lower cost and increasing use of routine care as compared to low income populations with Medicare only.