Objective: Out-of-pocket costs for insured patients have soared in recent years. Medicaid insurance for low-income individuals has minimal cost sharing but private insurance and Medicare have rising levels of cost-sharing that vary widely. We compared cost barriers and out-of-pocket expenditures among a national sample of adults with diabetes.
Methods: We used 2018-21 Medical Expenditure Panel Survey data to examine cost barriers. We categorized adults with diabetes into 3 groups: 1) low income (<250% federal poverty level [FPL]) on Medicaid; 2) low income on private insurance or Medicare; 3) high income (<u>></u>250% of FPL) on private insurance or Medicare. Logistic regression adjusted for age, sex, race, ethnicity, region, income (% of FPL), number of chronic conditions, self-rated health status, limitation of activities, and insulin use.
Results: We included a national sample of 6,219 adults with diabetes. Compared to low-income Medicaid recipients, low income and privately or Medicare-insured adults had higher reporting of delays or forgoing of medical care (OR=1.78, p=0.001) and medications (OR=1.45, p=0.01) due to cost. The high-income group had significantly higher odds of reporting delays and/or forgoing medication use (OR=1.58, p=0.005) but not medical care (OR=1.35, p=0.1). Out-of-pocket expenditures were significantly higher for private and Medicare insured adults compared to those in the low-income Medicaid group (low income, private or Medicare insurance group paid $267 more for medications and $755 more for care; high income group paid $315 and $967 more, respectively).
Conclusion: We found most adults with diabetes face cost barriers to care but low-income, privately or Medicare-insured adults are at highest risk of delaying or forgoing care and medication use due to cost. As the gap between rich and poor Americans widens, affordability of diabetes care will be harder to achieve, especially among low income privately or Medicare-insured adults.
H.A. Torres: None. T. Moin: None.
