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Introduction: Successful delivery of the virtual Medicare Diabetes Prevention Program (MDPP) is influenced by a beneficiary's access to a computer and use of the Internet., Methods: Using the 2020 nationally representative Medicare Current Beneficiary Survey Public Use File, a three-level categorical dependent variable was created: (1) has a computer AND uses Internet, (2) has a computer OR uses Internet, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was performed in 2023 to examine associations between socio-demographics, comorbidities, and computer access and Internet use., Results: Of study beneficiaries aged ≥65 years with BMI≥25 kg/m 2 and no history of diabetes (n=3,875), 70.8% had a computer AND used Internet; 14.3% had a computer OR used Internet; and 14.9% had no computer AND did not use Internet. Hispanics and non-Hispanic Blacks (OR=0.28, 95% CI [0.17-0.43]) were less likely than non-Hispanic Whites to have a computer AND use Internet. Beneficiaries with less education (

Objective: To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes., Methods: This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups., Results: Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7])., Conclusions: Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To examine patient attitudes, experiences, and satisfaction with healthcare associated with office visit utilization among Medicare beneficiaries with type 2 diabetes., Methods: We analyzed the 2019 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with type 2 diabetes ( n  = 1092). The ordinal dependent variable was defined as 0, 1 to 5, and ≥6 office visits. An ordinal partial proportional odds model was conducted to examine associations of beneficiaries' attitudes, experiences, and satisfaction with healthcare and office visit utilization., Results: Among the beneficiaries, approximately 17.7%, 22.8%, and 59.5% reported having 0, 1 to 5, and ≥6 office visits, respectively. Being male (OR = 0.67, p  = 0.004), Hispanic (OR = 0.53, p  = 0.006), divorced/separated (OR = 0.62, p  = 0.038) and living in a non-metro area (OR = 0.53, p  < 0.001) were associated with a lower likelihood of attending more office visits. Trying to keep sickness to themselves (OR = 0.66, p  = 0.002) and dissatisfaction with the ease and convenience of getting to providers from home (OR = 0.45, p  = 0.010) were associated with a lower likelihood of having more office visits., Discussion: The proportion of beneficiaries foregoing office visits is concerning. Attitudes concerning healthcare and transportation challenges can be barriers to office visits. Efforts to ensure timely and appropriate access to care should be prioritized for Medicare beneficiaries with diabetes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The purpose of the study was to examine the relationship between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills among Medicare beneficiaries with type 2 diabetes., Methods: The 2019 Medicare Current Beneficiary Survey Public Use File, a nationally representative sample of Medicare beneficiaries aged ≥65 years with type 2 diabetes, was analyzed (n = 2178). A survey-weighted multivariable logit regression model was conducted to examine the association between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills, adjusted for sociodemographics and comorbidities., Results: Among study beneficiaries, 12.6% reported problems paying medical bills. Among those with and without problems paying medical bills, 59.5% and 12.8%, respectively, were dissatisfied with out-of-pocket costs. In the multivariable analysis, beneficiaries who were dissatisfied with out-of-pocket costs were more likely to report problems paying medical bills than those who were satisfied. Younger beneficiaries, beneficiaries with lower incomes, those with functional limitations, and those with multiple comorbidities were more likely to report problems paying medical bills., Conclusions: Despite having health care coverage, more than one-tenth of Medicare beneficiaries with type 2 diabetes reported problems paying medical bills, which raises concerns about delaying or forgoing needed medical care due to unaffordability. Screenings and targeted interventions that identify and reduce financial hardships associated with out-of-pocket costs should be prioritized.

Introduction: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults., Methods: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy., Results: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment., Conclusion: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.

Introduction: Health care avoidance by Medicare beneficiaries with chronic conditions such as type 2 diabetes can result in adverse health and economic outcomes. The objective of this study was to describe factors associated with choices to avoid health care among Medicare beneficiaries with type 2 diabetes., Methods: We used a survey-weighted logistic model and the nationally representative 2016 Medicare Current Beneficiary Survey to analyze data on 1,782 Medicare beneficiaries aged ≥65 with type 2 diabetes, to examine associations between Medicare beneficiaries' decisions to avoid health care and multiple factors (eg, dissatisfaction with information given by providers, health problems that should have been discussed with providers but were not, worry about health more than other people their age)., Results: Of our study sample, 26.1% reported they avoid health care. Five factors were associated with avoiding health care: delaying care (vs not) because of costs (adjusted odds ratio [aOR] = 2.06; P = .005); having health problems that should have been discussed with providers but were not (vs having discussions) (aOR = 1.50; P = .04); worrying (vs not) about health more than other people their age (aOR = 2.13; P < .001); self-reporting "other" minority race (vs non-Hispanic White) (aOR = 2.01; P = .006); and education levels. Participants with less than a high school diploma (aOR = 1.95; P = .001) and participants with a high school diploma only (aOR = 1.49; P = .049) were more likely than participants with an education beyond high school to report avoiding health care., Conclusion: Approximately 1 in 4 Medicare beneficiaries with type 2 diabetes avoid health care. We found inequities in care-seeking behavior by race/ethnicity and education level. Health care perceptions and lack of appropriate discussion of health care concerns with health care providers are also associated with this behavior. Clinical interventions (eg, improved patient-provider communication) and educational outreach are needed to decrease the numbers of Medicare beneficiaries who avoid health care.

Background: Hypertension is highly prevalent among the low-income population in the United States. This study assessed the association between Medicaid coverage and health care service use and costs among hypertensive adults following the enactment of the Patient Protection and Affordable Care Act (ACA), by income status level., Methods: A nationally representative sample of 2,866 nonpregnant hypertensive individuals aged 18-64 years with income up to 138% of the federal poverty level (FPL) were selected from the 2014 and 2015 Medical Expenditure Panel Survey. Regression analyses were performed to examine the association of Medicaid coverage with outpatient (outpatient visits and prescription medication fills), emergency, and acute health care service use and costs among those potentially eligible for Medicaid by income status-the very low-income (FPL ≤ 100%) and the moderately low-income (100% > FPL ≤ 138%)., Results: Among the study population, 70.1% were very low-income and 29.9% were moderately low-income. Full-year Medicaid coverage was higher among the very low-income group (41.0%) compared with those moderately low-income (29.1%). For both income groups, having full-year Medicaid coverage was associated with increased health care service use and higher overall annual medical costs ($13,085 compared with $7,582 without Medicaid); costs were highest among moderately low-income patients ($17,639)., Conclusion: Low-income individuals with hypertension, who were potentially newly eligible for Medicaid under the ACA may benefit from expanded Medicaid coverage by improving their access to outpatient services that can support chronic disease management. However, to realize decreases in medical expenditures, efforts to decrease their use of emergency and acute care services are likely needed., (© American Journal of Hypertension, Ltd 2019. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

This study examined factors associated with the mental health of Medicare beneficiaries during the COVID-19 pandemic. The Medicare Current Beneficiary Survey COVID-19 Supplement administered in the Fall of 2020 of beneficiaries aged ≥65 years was analyzed (n = 6,173). A survey-weighted logistic model, adjusted for socio-demographics and comorbidities, was performed to examine factors (e.g., accessibility of medical/daily needs, financial security, and social connectivity) associated with stress/anxiety. Of Medicare beneficiaries, 40.8% reported feeling more stressed/anxious during the pandemic. Factors that were associated with this increased stress/anxiety include the inability to get home supplies (95% CI [3.4%, 16.5%]) or a doctor's appointment (95% CI [1.7%, 20.7%]), feeling less financially secure (95% CI [23.1%, 33.2%]) or socially connected (95% CI [19.1%, 25.6%]), and being female (95% CI [7.2%, 12.2%]), when compared with their respective counterparts. Non-Hispanic blacks were less likely to report feeling more stressed/anxious than non-Hispanic whites (95% CI [−19.9%, −9.0%]). Our findings highlight that beneficiaries' mental health was adversely influenced by the pandemic, particularly in those who felt financially insecure and socially disconnected. It is warranted to screen at risk beneficiaries for stress/anxiety during Medicare wellness visits and advocate for programs to reduce those risk factors. [ABSTRACT FROM AUTHOR]

Due to the influence types of telehealth services (i.e., phone and/or video) can have on patient care and outcomes, we sought to examine factors associated with the types of telehealth services offered and used among Medicare beneficiaries. We analyzed the Medicare Current Beneficiary Survey COVID-19 Public Use File (N = 1,403 and N = 2,218 for individuals with and without diabetes, respectively) and performed multinomial logit models to examine factors (e.g., sociodemographics, comorbidities, digital access/knowledge) associated with types of telehealth services offered and used among beneficiaries aged ≥65 years by diabetes status. Medicare beneficiaries seemed to prefer using telehealth via phone than video. Regardless of diabetes status, having not previously participated in video or voice calls or conferencing can be a barrier to telehealth being offered and used via video for beneficiaries. For older adults with diabetes, disparities in accessibility of telehealth via video by income and languages spoken other than English were observed. [Research in Gerontological Nursing, 16(3), 134–146.] [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives: This study aims to investigate how reported comprehension of the Medicare programme and its prescription drug benefits is associated with cost‐related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors. Methods: This cross‐sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smoking and obesity) (n = 2821). A survey‐weighted logistic model was used to examine associations between perceived difficulty of understanding the Medicare programme and its prescription drug benefits and CRN, controlling for beneficiaries' demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved. Results: Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare programme and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare programme (OR = 1.50; 95% CI = 1.11−2.04; p = 0.009) and its prescription drug benefits (OR = 2.01; 95% CI = 1.52−2.66; p < 0.001). Similar results were obtained for the subgroups with obesity, hypertension or hyperlipidemia. Conclusions: Perceived difficulty of understanding the Medicare Programme and its prescription drug benefits is associated with CRN among Medicare beneficiaries with CVD risk factors, especially those with obesity, hypertension or hyperlipidemia. Monitoring and enhancing Medicare beneficiaries' overall understanding of the Medicare programme may reduce CRN. [ABSTRACT FROM AUTHOR]

The removal of regulatory and reimbursement barriers during the COVID‐19 pandemic in the United States presented opportunities to explore the potential of telehealth to improve access to and use of healthcare among underserved populations. Therefore, we examined factors associated with accessibility and utilisation of telehealth among older adults during the COVID‐19 pandemic. We analysed the nationally representative Medicare Current Beneficiary Survey COVID‐19 Supplement File of community‐dwelling Medicare beneficiaries aged ≥65 years (n = 5,189), administered from 5 October 2020, through 15 November 2020. Two survey‐weighted multivariable logistic regression models were used to assess the association between factors (i.e., socio‐demographics, co‐morbidities and digital access/literacy) and whether (1) beneficiaries' regular providers offered telehealth during the COVID‐19 pandemic, and (2) those being offered telehealth used it. Furthermore, subgroup analyses by residing area and income status were conducted. Of study beneficiaries, 83.6% reported their regular providers offered telehealth during COVID‐19. Disparities in accessibility of telehealth by sociodemographic status were observed [e.g., those living in a non‐metro area (versus metro) were 7.1% (marginal effect [ME] = −7.1%; p < 0.01) less likely to report accessibility of telehealth]. Beneficiaries who had no access to internet (ME = −8.2%; p < 0.001) and had not participated in video/voice calls/conferencing prior (versus participated) (ME = −6.6%; p < 0.001) were less likely to report having access to telehealth. Among those being offered telehealth services, 43.0% reported using telehealth services. Hispanic and Non‐Hispanic Black beneficiaries (e.g., Black versus White; ME = 11.3%; p < 0.01) and those with co‐morbidities (versus 0–1 condition) (e.g., 2–3 co‐morbidities, ME = 7.3%; p < 0.01) were more likely to report using telehealth services when offered. Similar results were observed in the subgroup analyses regarding disparities in accessibility and utilisation of telehealth. The accessibility and utilisation of telehealth have increased amidst the pandemic; however, disparities in accessibility of telehealth were observed. A telehealth triage protocol is needed to ensure underserved patients continue to receive appropriate care. [ABSTRACT FROM AUTHOR]

Medication nonadherence among older patients with cancer can have profound health consequences. This study examines the association between prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer. We analyzed the 2017 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with reported non-skin cancer (n = 806). Beneficiaries were considered to have medication nonadherence if they reported: skipping doses, taking smaller doses than prescribed, or delaying or not filling a prescription because of cost. A survey-weighted logistic model, adjusted for covariates, was conducted to examine the association between prescription drug coverage satisfaction and medication nonadherence. Of study beneficiaries with cancer, 14.7% reported medication nonadherence. Higher proportions of beneficiaries with medication nonadherence were dissatisfied with the amount paid for medications (33.2% vs. 11.0%, p < 0.001) and the medications included on formulary (29.5% vs 5.2%, p < 0.001). In the adjusted analysis, the risk for medication nonadherence was higher among those who were dissatisfied with the amount paid for medications (OR = 2.22; p = 0.050) and the medications included on formulary (OR = 5.03; p = 0.005). Strategic mitigation of these barriers is essential to improving health outcomes in this at-risk population. [ABSTRACT FROM AUTHOR]

Objectives The public relies on various media sources and communication platforms for receipt of coronavirus disease 2019 (COVID-19) information. Therefore, identifying the primary sources of COVID-19 information among older adults can be valuable, as it can enable information on life-saving measures to be effectively disseminated to this population. Methods We analyzed the Medicare Current Beneficiary Survey COVID-19 Supplement that was administrated from June 2020 through July 2020 (n = 8,050). A survey-weighted logistic model was conducted to examine the association between the sources of COVID-19 information Medicare beneficiaries most relied on (i.e. traditional news sources, social media, comments/guidance from government officials, other webpages/internet, friends/family members, and health care providers) and engaging in all 3 recommended preventive behaviors (i.e. mask wearing, social distancing, and handwashing). Results Among study participants, 89.8% engaged in all 3 recommended preventive behaviors. Approximately 59.3% of beneficiaries reported that they most relied upon traditional news sources for COVID-19 information; 11.4% reported health care providers; 10.6% reported comments/guidance from government officials; 8.8% reported other webpages/internet; 8.6% reported friends/family members; and 1.3% reported they relied upon social media. Beneficiaries who relied on comments/guidance from government officials for COVID-19 information (vs. traditional news sources) were more likely to engage in preventive behaviors (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.20–2.35). However, those who relied on COVID-19 information from friends/family members (vs. traditional news sources) were less likely to engage in preventive behaviors (OR = 0.56, 95% CI = 0.44–0.73). Discussion Our findings can inform decision making about the effective communication sources to reach Medicare beneficiaries for public health messaging regarding preventive measures, including COVID-19 vaccination. [ABSTRACT FROM AUTHOR]