Medicare Costs Higher Among Previously Uninsured Beneficiaries

Research in the July 12 New England Journal of Medicine demonstrates a link between lack of health insurance among people ages 51 to 61 and higher medical expenditures when those people qualified for Medicare at age 65.

In the article "Use of Health Services by Previously Uninsured Medicare Beneficiaries," researchers note that when previously uninsured older adults -- those ages 51-61 -- qualified for Medicare, their self-reported health care expenditures were 51 percent higher than those who had been otherwise insured before they qualified for Medicare.

Lead researcher John Ayanian, M.D., associate professor of medicine and health care policy at Harvard Medical School, Boston, and his co-authors used data from the Health and Retirement Study, a nationally representative, longitudinal survey, to assess self-reported health care use and expenditures for 5,158 insured and uninsured older adults from 1992 to 2004.

Previously uninsured respondents with hypertension, diabetes, heart disease, or stroke "reported significantly greater increases in the numbers of doctor visits and hospitalizations and in total medical expenditures than did previously insured adults," with similar conditions, write Ayanian and his co-authors.

When compared with their insured counterparts with similar health conditions, previously uninsured patients reported 13 percent more doctor visits, 20 percent more hospitalizations and 51 percent more medical expenses after they qualified for Medicare. Moreover, use of Medicare-funded health services for previously uninsured patients with cardiovascular disease or diabetes remained elevated through age 72, "indicating that the earlier lack of insurance was associated with persistent increases in health care needs rather than with transient spikes," the authors write.

They suggest that providing health insurance coverage for uninsured older adults -- particularly those with cardiovascular disease or diabetes -- could improve these patients' health outcomes and reduce their health care use and spending after age 65.

"These benefits may be substantial and may partially offset the costs of expanding coverage," write the authors.