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Women are vulnerable to coverage and care gaps when their husbands transition to Medicare

Research Activities, October 2009

Employers do not often offer retiree health benefits once a former employee is eligible for Medicare. Consequently, some near-elderly women (aged 62 to 64) experience disruptions in their insurance coverage as their husbands turn 65 and transition to Medicare, a new study finds. Women whose coverage was interrupted had a 71 percent increased probability of changing their normal care provider or clinic and a 75 percent greater probability of delaying a prescription fill or taking less medication than prescribed because of cost. They also had a 52 percent increased probability of seeking care at the emergency department, and had lower mental health scores than women whose insurance was not disrupted.

Coverage disruptions can be especially troubling, because two-thirds of the women in the study had one or more chronic condition for which disjointed care could lead to adverse consequences. The authors suggest that health systems and insurers should adopt strategies to encourage continuous care access to reduce the effects of insurance changes.

On the positive side, women who experienced insurance disruptions had a 40 percent increased probability of having a pelvic exam or Pap smear compared with women who did not have any change in insurance. A likely explanation for this increased screening is that the women switched to new insurers during the disruption, and prior research has shown that diagnostic testing, such as Pap tests, is high within the initial years of plan enrollment.

This study used data from 655 women enrolled in the Wisconsin Longitudinal Study and was funded in part by the Agency for Healthcare Research and Quality (T32/HS00083).

See "Insurance disruption due to spousal Medicare transitions: Implications for access to care and health care utilization for women approaching age 65," by Jessica R. Schumacher, M.S., Maureen A. Smith, M.D., Ph.D., M.P.H., Jinn-Ing Liou, M.S., and Nancy Pandhi, M.D., M.P.H., in the June 2009 Health Services Research 44(3), pp. 946-964.

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Page last reviewed October 2009
Internet Citation: Women are vulnerable to coverage and care gaps when their husbands transition to Medicare: Research Activities, October 2009. October 2009. Agency for Healthcare Research and Quality, Rockville, MD.