Out-of-Pocket Health Care Spending Among Medicare Beneficiaries Before and During the COVID-19 Pandemic
Author(s)
Boon Peng Ng, PhD1, Jacqueline Lamanna, PhD1, Nicha Thiamwong, earning BSc1, Georgianne Tiu Hawkins, DrPH, MPH2, Yingru Li, PhD1, Chanhyun Park, MEd, RPh, PhD3;
1University of Central Florida, Orlando, FL, USA, 2University of Kentucky, Lexington, KY, USA, 3University of Texas at Austin, Austin, TX, USA
1University of Central Florida, Orlando, FL, USA, 2University of Kentucky, Lexington, KY, USA, 3University of Texas at Austin, Austin, TX, USA
OBJECTIVES: In 2019, about 50% of the 60 million Medicare beneficiaries had incomes below $29,650, and in 2021, 13% lived below the federal poverty level. The disproportionate impact of COVID-19 on older adults and minorities raised concerns about their out-of-pocket healthcare spending. Therefore, this study aimed to estimate out-of-pocket healthcare spending by demographic characteristics among beneficiaries aged ≥65 years before and during the COVID-19 pandemic.
METHODS: We analyzed the 2019 and 2021 Medicare Current Beneficiary Survey Cost files of beneficiaries aged ≥65 years (2019, n=6,895; 2021, n=6,094). Survey-weighted generalized linear models with a log link and gamma distribution with a three-way interaction of sex (male, female), age (65-74, ≥75), and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Other), adjusted for covariates and to 2021 US dollars, were conducted to estimate annual out-of-pocket spending.
RESULTS: Among study beneficiaries, average annual out-of-pocket spending per person was $2,511 in 2019 and $2,641 in 2021. Beneficiaries who identified as non-Hispanic Black had lower out-of-pocket spending compared with non-Hispanic Whites in both years (e.g., 2021, $2,139 95%CI [$1,761-$2,517] vs. $2,730 [$2,580-$2,879]). Beneficiaries aged 65-74 years who were non-Hispanic Black had lower out-of-pocket spending than non-Hispanic Whites in the same age group for both years (e.g., 2021, $1,740 [$1,396-$2,085] vs. $2,699 [$2,481-$2,917]). Several demographic groups had either lower or higher out-of-pocket spending in 2019 (e.g., non-Hispanic Whites spent more than those identified as Other) than in 2021.
CONCLUSIONS: Out-of-pocket spending can be a significant financial burden and varied by demographic factors before and during the COVID-19 pandemic. There is a need to better understand the characteristics (e.g., access to care, healthcare avoidance, and participation in Medicare Savings Programs) that contribute to differences in out-of-pocket spending across different groups. Additionally, emphasis should be placed on implementing policies and practices that can reduce out-of-pocket spending for at-risk beneficiaries.
METHODS: We analyzed the 2019 and 2021 Medicare Current Beneficiary Survey Cost files of beneficiaries aged ≥65 years (2019, n=6,895; 2021, n=6,094). Survey-weighted generalized linear models with a log link and gamma distribution with a three-way interaction of sex (male, female), age (65-74, ≥75), and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Other), adjusted for covariates and to 2021 US dollars, were conducted to estimate annual out-of-pocket spending.
RESULTS: Among study beneficiaries, average annual out-of-pocket spending per person was $2,511 in 2019 and $2,641 in 2021. Beneficiaries who identified as non-Hispanic Black had lower out-of-pocket spending compared with non-Hispanic Whites in both years (e.g., 2021, $2,139 95%CI [$1,761-$2,517] vs. $2,730 [$2,580-$2,879]). Beneficiaries aged 65-74 years who were non-Hispanic Black had lower out-of-pocket spending than non-Hispanic Whites in the same age group for both years (e.g., 2021, $1,740 [$1,396-$2,085] vs. $2,699 [$2,481-$2,917]). Several demographic groups had either lower or higher out-of-pocket spending in 2019 (e.g., non-Hispanic Whites spent more than those identified as Other) than in 2021.
CONCLUSIONS: Out-of-pocket spending can be a significant financial burden and varied by demographic factors before and during the COVID-19 pandemic. There is a need to better understand the characteristics (e.g., access to care, healthcare avoidance, and participation in Medicare Savings Programs) that contribute to differences in out-of-pocket spending across different groups. Additionally, emphasis should be placed on implementing policies and practices that can reduce out-of-pocket spending for at-risk beneficiaries.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE437
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas