Estenson Lilly, Roberts Eric T, Jacobson Mireille
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Innov Aging. 2024 Dec 9;9(1):igae105. doi: 10.1093/geroni/igae105. eCollection 2025.
Medicare coverage decisions are complex. The Centers for Medicare & Medicaid Services (CMS) provides a hotline, handbook, and website to help Medicare beneficiaries understand their benefits and coverage options, yet it is unclear what factors affect beneficiary use of these resources. We examined limited English speaking and English reading proficiency status as predictors of CMS Medicare informational resource use in a nationally representative sample of Medicare beneficiaries.
We used 2016-2018 Medicare Current Beneficiary Survey data and linear probability models to assess whether the likelihood of using CMS Medicare informational resources differed among beneficiaries with limited English proficiency. We adjusted models for demographic, socioeconomic, health, and local market factors and, in sensitivity analyses, health insurance characteristics. Our primary outcome was an indicator of having previously used at least 1 of the 3 CMS resources.
Among noninstitutionalized beneficiaries ( = 20 715), 4.8% had limited English speaking proficiency, 7.0% had limited English reading proficiency, and 67.7% had used at least 1 CMS resource. After regression adjustment, beneficiaries with limited English reading proficiency were 16.3 percentage points less likely to have used a CMS resource compared to beneficiaries who reported English reading proficiency ( < .001). Limited English speaking proficiency was not associated with CMS resource use.
These findings suggest that English reading proficiency may be an underappreciated factor in Medicare beneficiaries' use of the Medicare handbook, hotline, and website. Alternative approaches to providing and publicizing informational resources may reduce barriers to Medicare resource use among beneficiaries with limited English reading proficiency.
医疗保险覆盖范围的决策很复杂。医疗保险与医疗补助服务中心（CMS）提供了一条热线、一本手册以及一个网站，以帮助医疗保险受益人了解他们的福利和覆盖选项，但尚不清楚哪些因素会影响受益人对这些资源的使用。我们在全国具有代表性的医疗保险受益人样本中，研究了英语听说能力有限和英语阅读能力有限的状况，以此作为CMS医疗保险信息资源使用情况的预测指标。
我们使用了2016 - 2018年医疗保险当前受益人调查数据和线性概率模型，来评估英语水平有限的受益人使用CMS医疗保险信息资源的可能性是否存在差异。我们对人口统计学、社会经济、健康和当地市场因素的模型进行了调整，在敏感性分析中还调整了医疗保险特征。我们的主要结果是一个是否曾使用过3种CMS资源中至少1种的指标。
在非机构化受益人（n = 20715）中，4.8%的人英语听说能力有限，7.0%的人英语阅读能力有限，67.7%的人至少使用过1种CMS资源。经过回归调整后，与报告有英语阅读能力的受益人相比，英语阅读能力有限的受益人使用CMS资源的可能性要低16.3个百分点（P <.001）。英语听说能力有限与CMS资源使用情况无关。
这些发现表明，英语阅读能力可能是医疗保险受益人使用医疗保险手册、热线和网站时一个未得到充分重视的因素。提供和宣传信息资源可供选择的方法，可能会减少英语阅读能力有限的受益人在使用医疗保险资源方面的障碍。
