Uninsured Benefit Once They Are Covered by Medicare

By Alan Mozes
HealthDay Reporter
Thursday, December 27, 2007; 12:00 AM

THURSDAY, Dec. 27 (HealthDay News) -- People who are intermittently or totally uninsured in the decade prior to reaching Medicare eligibility experience substantial improvements in health once such coverage kicks in, a new study reveals.

In fact, previously uninsured people appeared to experience greater relative health gains during their post-65 Medicare years than did previously insured patients, particularly those diagnosed with heart disease and diabetes.

The findings suggest that Medicare dramatically reverses a trend toward rapid health deterioration among the previously uninsured "near-elderly," the study authors said.

"Our study shows that near-elderly adults -- those 55 to 64 -- who are uninsured have much greater declines in health before age 65," said co-author Dr. John Z. Ayanian, a professor of health care policy and medicine at Harvard Medical School and Brigham and Women's Hospital, both in Boston. "But once they become eligible for Medicare at 65, they do relatively better than people who were continuously insured before, in terms of improving their health."

The findings were reported in the Dec. 26 issue of theJournal of the American Medical Association.

To assess changes in health status among people before and after they entered into Medicare coverage, the authors analyzed data collected by the Health and Retirement Study, a national survey started in 1992.

Slightly more than 7,200 men and women participated. All were between the ages of 51 and 61 at the study's start, ensuring that the study cohort would include participants who would reach the age of Medicare eligibility (65) at some point through 2004.

Starting at age 55, the participants completed questionnaires on a biannual basis regarding their health insurance status, indicating whether they had lacked coverage at any point in the prior two years.

Those with continuous coverage prior to age 65 were classified as "insured." Among those reporting coverage gaps, men and women who had lacked insurance for more than half of the period between ages 55 and 64 were classified as "persistently uninsured." Those with some coverage beyond that threshold were classified as "intermittently uninsured."

Continuing until the age of 72, all participants were also asked to assess their general health status, reporting on their physical function abilities, mental health, pain experience, mobility, and depressive symptoms. The researchers ranked the responses, and assigned patients scores for all health issues.

Patients were also asked to indicate if they were diabetic and to report all incidences of heart attack, hospitalization for heart failure, and debilitative angina -- chest pain.

The study authors found that slightly more than 5,000 of the survey participants -- almost 70 percent -- had been continuously insured before receiving Medicare. Just over 2,200 were either intermittently or continuously uninsured between 55 and 64.

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