High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999-2017

Abstract

Objective: We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries age 65 years or older with diabetes overall, by income level, by race/ethnicity, and compared with beneficiaries without diabetes.

Research design and methods: Using data from the 1999-2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD.

Results: Total OOP costs were $3,609-$5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57%-72% at the 10% income threshold and 29%-41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25-50% income quartiles. Non-Hispanic Whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, P < 0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, P < 0.01).

Conclusions: Over the past two decades, Medicare beneficiaries age 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.

Figure 1—

Mean annual total OOP costs (2017 USD) and prevalence of high OOP burden (>10% and >20% of pretax income) among Medicare beneficiaries with diabetes (≥65 years old), 1999 – 2017.

Figure 2—

Mean annual total OOP costs and prevalence of high OOP burden (>10% and >20% of pretax income) by income quartile among Medicare beneficiaries with diabetes (≥65 years old), 1999 – 2017. A: Mean annual total OOP costs (2017 USD) by income level. B: Percentage prevalence of beneficiaries with high OOP burden that exceeded 10% of their pretax income by income level. C: Percentage prevalence of beneficiaries with high OOP burden that exceeded 20% of their pretax income by income level.

Figure 3—

Mean annual total OOP costs and prevalence of high OOP burden (>10% and >20% of pretax income) by race/ethnicity among Medicare beneficiaries with diabetes (≥65 years old), 1999 – 2017. A: Mean annual total OOP costs (2017 USD) by race/ethnicity. B: Percentage prevalence of beneficiaries with high OOP burden that exceeded 10% of their pretax income by race/ethnicity. C: Percentage prevalence of beneficiaries with high OOP burden that exceeded 20% of their pretax income by race/ethnicity.