Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
JAMA Intern Med. 2013 Jun 24;173(12):1100-7. doi: 10.1001/jamainternmed.2013.845.
Take-up of the Medicare Part D low-income subsidy (LIS) by eligible beneficiaries has been low despite the attractive drug coverage it offers at no cost to beneficiaries and outreach efforts by the Social Security Administration.
To examine the role of beneficiaries' cognitive abilities in explaining this puzzle.
Analysis of survey data from the nationally representative Health and Retirement Study.
Elderly Medicare beneficiaries who were likely eligible for the LIS, excluding Medicaid and Supplemental Security Income recipients who automatically receive the subsidy without applying.
Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions.
Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5% vs 52.0%; P = .002), LIS awareness (58.3% vs 33.3%; P = .001), and LIS application (25.5% vs 12.7%; P < .001). Lower numeracy was also associated with lower rates of Part D enrollment (P = .03) and LIS application (P = .002). Reported receipt of the LIS was associated with significantly lower annual out-of-pocket drug spending (adjusted mean difference, -$256; P = .02) and premium costs (-$273; P = .02).
Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors.
尽管医疗保险处方药计划（Part D）低收 入补贴（LIS）为受益人提供了无成本的有吸引力的药物覆盖范围，但符合条件的受益人对该补贴的利用率仍然很低，这令人费解。这一现象尽管社会保障管理局（Social Security Administration）进行了外联工作，但仍然存在。
研究受益人的认知能力在解释这一谜团中的作用。
对全国代表性健康与退休研究（Health and Retirement Study）的调查数据进行分析。
有资格获得 LIS 的老年医疗保险受益人，不包括医疗补助（Medicaid）和补充保障收入（Supplemental Security Income）的接受者，这些人无需申请就自动获得补贴。
利用 2006 年至 2010 年的调查评估，我们研究了认知能力与自我报告的 Part D 参保情况、对 LIS 的认知程度和申请 LIS 之间的关系。我们还比较了符合 LIS 资格但未报告获得 LIS 的受益人和报告获得 LIS 的受益人的自付药物支出和保费成本。分析结果调整了社会人口特征、家庭收入和资产、健康状况和慢性病的存在情况。
与整体认知能力处于前四分之一的 LIS 合格受益人相比，处于后四分之一的受益人的 Part D 参保率（调整后的比率，63.5%比 52.0%；P =.002）、LIS 意识（58.3%比 33.3%；P =.001）和 LIS 申请率（25.5%比 12.7%；P <.001）明显较低。较低的计算能力也与较低的 Part D 参保率（P =.03）和 LIS 申请率（P =.002）相关。报告获得 LIS 与较低的年度自付药物支出（调整后的平均差异，-256 美元；P =.02）和保费成本（-273 美元；P =.02）显著相关。
在符合 Part D LIS 资格的医疗保险受益人中，较差的认知和计算能力与较低的报告利用率相关。目前鼓励申请 LIS 的教育和外联工作可能对处理和回应信息能力有限的受益人来说还不够。可能需要额外的政策将 LIS 提供的经济保护扩大到所有符合条件的老年人。
