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, Maureen A. Smith, Jinn-Ing Liou, Nancy Pandhi
HSR
June 2009
Objective: To assess whether a husband’s Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.
Principal Findings: After adjustment, women who experienced an insurance disruption due to their husband’s Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.
Conclusions: Despite consistent insurance coverage, the insurance disruption that accompanies a spouse’s Medicare transition has adverse access and health care utilization consequences for women.
http://www.hsr.org/hsr/abstract.jsp?aid=44347877138

Most individuals experience a sense of relief on turning 65 because they know that they have the security of being covered by Medicare for the remainder of their lives. But that relief is often tempered by concerns over the transitional problem of having a wife who is not yet 65, but who experiences a disruption in her insurance because she had been covered as a dependent on her husband’s plan. This study demonstrates that such disruptions can have adverse consequences for health care.
How would the current reform proposals address this problem? Likely she would be mandated to purchase an individual plan through the insurance exchange, probably at a higher premium since plans would be allowed to use age as a factor in setting rates. This could be quite expensive just at a time that the couple is trying to pull together their financial plans for their retirement years. Also since almost all private health plans assess financial penalties for failure to use their contracted providers, she could lose the choice of continuing to use her current health care professionals. What would happen if she has a serious medical problem and has already initiated a complicated medical regimen (e.g., cancer chemotherapy, radiation, and staged surgery)?
Should Congress include in the reform legislation a measure that would cover the spouse under Medicare once the eligible individual turns 65? If so, should the taxpayers fund that coverage, even if the spouse is 32? If, instead, a premium is to be paid, would it be based on the actuarial value of a risk pool composed of high-cost retirees and individuals with long-term disabilities (i.e., the current Medicare program)? If the husband is leaving an employer-sponsored plan, would the former employer be required to continue the spouse’s coverage to avoid transitional disruptions? If so, who pays and how much?
We will always face these issues and many more as long as Congress insists that we are each mandated to finance our health care through our fragmented, dysfunctional, multi-payer insurance system.
All we really need to do is fix Medicare, and then make enrollment automatic for everyone. But then that would break the bond of trust that President Obama and the members of Congress have established with Karen Ignagni. That seems to be a much stronger bond than they have with the other 306 million of us.

By Jessica R. Schumacher, Maureen A. Smith, Jinn-Ing Liou, Nancy Pandhi
HSR
June 2009

Objective: To assess whether a husband’s Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.

Principal Findings: After adjustment, women who experienced an insurance disruption due to their husband’s Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.

Conclusions: Despite consistent insurance coverage, the insurance disruption that accompanies a spouse’s Medicare transition has adverse access and health care utilization consequences for women.

http://www.hsr.org/hsr/abstract.jsp?aid=44347877138

Comment:

By Don McCanne, MD

Most individuals experience a sense of relief on turning 65 because they know that they have the security of being covered by Medicare for the remainder of their lives. But that relief is often tempered by concerns over the transitional problem of having a wife who is not yet 65, but who experiences a disruption in her insurance because she had been covered as a dependent on her husband’s plan. This study demonstrates that such disruptions can have adverse consequences for health care.

How would the current reform proposals address this problem? Likely she would be mandated to purchase an individual plan through the insurance exchange, probably at a higher premium since plans would be allowed to use age as a factor in setting rates. This could be quite expensive just at a time that the couple is trying to pull together their financial plans for their retirement years. Also since almost all private health plans assess financial penalties for failure to use their contracted providers, she could lose the choice of continuing to use her current health care professionals. What would happen if she has a serious medical problem and has already initiated a complicated medical regimen (e.g., cancer chemotherapy, radiation, and staged surgery)?

Should Congress include in the reform legislation a measure that would cover the spouse under Medicare once the eligible individual turns 65? If so, should the taxpayers fund that coverage, even if the spouse is 32? If, instead, a premium is to be paid, would it be based on the actuarial value of a risk pool composed of high-cost retirees and individuals with long-term disabilities (i.e., the current Medicare program)? If the husband is leaving an employer-sponsored plan, would the former employer be required to continue the spouse’s coverage to avoid transitional disruptions? If so, who pays and how much?

We will always face these issues and many more as long as Congress insists that we are each mandated to finance our health care through our fragmented, dysfunctional, multi-payer insurance system.

All we really need to do is fix Medicare, and then make enrollment automatic for everyone. But then that would break the bond of trust that President Obama and the members of Congress have established with Karen Ignagni. That seems to be a much stronger bond than they have with the other 306 million of us.