People with diabetes face higher out-of-pocket (OOP) health care costs than those without diabetes. This burden can lead to low adherence to treatments and adverse health outcomes, particularly among older adults. The OOP burden in older adults with diabetes has not been studied in the U.S. We estimated the OOP burden from 1999-2015 in Medicare beneficiaries with diabetes aged ≥65 using the Medicare Current Beneficiary Survey. OOP costs included premiums, deductibles, copays, coinsurance, and payments not covered by insurance. High OOP burden was defined as a person’s OOP costs ≥ 10% of their income. We estimated the prevalence of high OOP burden in all beneficiaries, by income quartile, and by race/ethnicity. Average OOP costs ranged from $2,864 to $4,212 (2015 $) and the percentage of those with high OOP burden varied from 38% to 46%, with slight increases over time. By income quartile, the average OOP costs were $2,292, $3,661, $4,032, and $4,430 for <25%, 25-50%, 50-75% and >75% groups, with decreases only in <25% group over time. There were large income-related disparities in prevalence of high OOP burden, with the highest in 25-50% group. Non-Hispanic whites had the highest prevalence of high OOP burden. In elderly Medicare beneficiaries with diabetes, OOP burden was high and increased over time, with large income-related disparities. Efforts to reduce both OOP burden and disparities in this population may be needed.


J. Park: None. Y. Wang: None. K.A. Look: None. E. Luman: None. P. Zhang: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at