Inadequate Insurance Research Articles

EP249: Practical implementation of inpatient rapid comprehensive sequencing for critically ill pediatric patients

The utility of inpatient rapid exome and genome sequencing has been well documented, but implementation continues to be hampered by inadequate insurance reimbursement, clinical genetics support availability, and high costs. Since late 2019, CS Mott Children’s Hospital at the University of Michigan has implemented a process through which critically ill pediatric patients can be evaluated with rapid comprehensive sequencing. After consideration of pre-determined criteria, each case is proposed by a consulting Pediatric Geneticist and then promptly evaluated by a multi-disciplinary committee (including Pediatric Geneticists, Cardiologist, Pediatric and Neonatal intensivists, and Neurologist).

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

A qualitative study of barriers to care-seeking for diabetic foot ulceration across multiple levels of the healthcare system

IntroductionThe mechanisms for the observed disparities in diabetes-related amputation are poorly understood and could be related to access for diabetic foot ulceration (DFU) care. This qualitative study aimed to understand patients’ personal experiences navigating the healthcare system and the barriers they faced.MethodsFifteen semi-structured interviews were conducted over the phone between June 2020 to February 2021. Participants with DFUs were recruited from a tertiary referral center in Southern Arizona. The interviews were audio-recorded and analyzed according to the NIMHD Research Framework, focusing on the health care system domain.ResultsAmong the 15 participants included in the study, the mean age was 52.4 years (66.7% male), 66.7% was from minority racial groups, and 73.3% was Medicaid or Indian Health Service beneficiaries. Participants frequently reported barriers at various levels of the healthcare system.On the individual level, themes that arose included health literacy and inadequate insurance coverage resulting in financial strain. On the interpersonal level, participants complained of fragmented relationships with providers and experienced challenges in making follow-up appointments. On the community level, participants reported struggles with medical equipment.On the societal level, participants also noted insufficient preventative foot care and education before DFU onset, and many respondents experienced initial misdiagnoses and delays in receiving care.ConclusionsPatients with DFUs face significant barriers in accessing medical care at many levels in the healthcare system and beyond. These data highlight opportunities to address the effects of diabetic foot complications and the inequitable burden of inadequately managed diabetic foot care.

Diabetes Prevalence Among Underserved Older Adults in the US: The Case of Native Hawaiians and Pacific Islanders

The effects of chronic diabetes among older adults in the United States represent ongoing challenges in diagnosis, treatment, comorbidities, amputations, and the increased risk of death. These challenges are made more complicated among underserved populations due to limited access to healthcare, medication costs, and later diagnosis of the condition. These issues are particularly true for the NHPI population, which has high rates of lifetime diabetes, greater levels of poverty, and inadequate health insurance. Useful statistics about diabetes among the NHPI have been difficult to obtain due to their small population size and lack of inclusion in federal health surveys. While early work by Panapasa examined prevalence among NHPI males in California, no reliable measures of diabetes among older NHPI’s existed at the national level. Released in 2017, the 2014 Native Hawaiian Pacific Islander National Health Interview Survey represents the first representative survey of the health and socio-economic correlates for this population, allowing the examination of health conditions such as diabetes at the national level. This presentation will examine the prevalence of diabetes among NHPI’s aged 60 and older and the impacts of this disease on overall health and quality of life. The paper will use the NHPI-NHIS to examine the use and access to diabetic medications and overall access to affordable health care. The paper will examine differences by age group, gender, immigration status, and ethnicity. While we know the overall prevalence of diabetes is high, this paper will offer new information on differentials within the older NHPI population.

The Impact of Medicare Health Insurance Coverage on Lung Cancer Screening.

Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk. A total of 11,163 individuals at high risk for lung cancer just above and below age 65. Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months. A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%-30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: -19.8% to 23.0%, P=0.88). Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.

The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons.

The COVID-19 run on medical resources crashed Wuhan’s medical care system, a medical disaster duplicated in many countries facing the COVID-19 pandemic. In a novel approach to understanding the run on Wuhan’s medical resources, we draw from bank run theory to analyze the causes and consequences of the COVID-19 run on Wuhan’s medical resources and recommend policy changes and government actions to attenuate runs on medical resources in the future. Like bank runs, the cause of the COVID-19 medical resource run was rooted in China’s local medical resource context and a sudden realignment of expectations, reflecting shortages and misallocations of hospital resources (inadequate liquidity and portfolio composition); high level hospitals siphoning-off patients from lower level health providers (bank moral hazard and adverse selection problem); patients selecting high-level hospitals over lower-level health care (depositor moral hazard problem); inadequate government oversight and uncontrolled risky hospital behavior (inadequate bank regulatory control); biased medical insurance schemes (inadequate depositor insurance); and failure to provide medical resource reserves (failure as lender of last resort). From Wuhan’s COVID-19 run on medical resources, we recommend that control and reform by government enlarge medical resource supply, improve the capacity of primary medical care, ensure timely virus information, formulate principles for the allocation of medical resources that suit a country’s national conditions, optimize the medical insurance schemes and public health fund allocations and enhance the emergency support of medical resources.

Distance Delivery of Function-Based Skill Training for Providers in Rural Settings

Children with diagnosed disabilities, teachers and classroom staff, and families living in rural areas have difficulty accessing any and all behavioral services, including parent training, due to a lack of providers, distance to clinics, cost of transportation, low income and/or inadequate health insurance, and confidentiality concerns from living in small communities. In this study, Project ECHO (Extension for Community Healthcare Outcomes) was used to train early childhood professionals on how to implement Prevent–Teach–Reinforce for Young Children, which is a step-by-step manualized approach to the assessment and treatment of challenging behavior that reflects a commitment to evidence-based practice. Results of the pilot study, study limitations, and future directions are discussed.

LB763 Characteristics and outcomes of dermatologic patient assistance programs

Several biologics and small molecule inhibitors are approved for psoriasis and atopic dermatitis; however, high costs limit accessibility for patients with inadequate insurance. Patient Assistance Programs (PAPs) are designed to provide free or discounted medications. This study characterizes PAPs for patient-administered biologics and small molecule inhibitors with FDA-approval for psoriasis and atopic dermatitis. Online PAP application forms for 13 medications were reviewed for application characteristics, patient eligibility, and outcomes.

Exploring the barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a qualitative study

BackgroundThe complexity of chronic obstructive pulmonary disease (COPD) and its different physical, mental, familial, occupational, and social complications highlight the necessity of pulmonary rehabilitation (PR) for afflicted patients. However, PR for patients with COPD usually faces some barriers. The aim of this study was to explore the barriers to PR for patients with COPD.MethodsThis qualitative descriptive study was conducted in January 2019 to October 2020. Participants were 19 patients with COPD, 11 family caregivers of patients with COPD, and 12 healthcare providers, who all were recruited purposively from two teaching hospitals in Isfahan, Iran. Data were collected through semi-structured interviews and were analyzed through conventional content analysis.ResultsThe barriers to PR for patients with COPD fell into three main categories, namely barriers related to patients and their families, inefficiency of PR services, and inappropriate organizational context for PR. Each category had four subcategories, namely patients’ and families’ lack of knowledge, complexity and chronicity of COPD, heavy financial burden of COPD, patients’ frustration and discontinuation of PR, lack of patient-centeredness, lack of coordination in PR team, inadequate professional competence of PR staff, lack of a holistic approach to PR, limited access to PR services, inadequate insurance for PR services, ineffective PR planning, and discontinuity of care.ConclusionPR for patients with COPD is a complex process which faces different personal, familial, social, financial, organizational, and governmental barriers. Strategies for managing these barriers are needed in order to improve the effectiveness and the quality of PR services for patients with COPD.

Health services utilization, out-of-pocket expenditure, and underinsurance among insured non-elderly cancer survivors in the United States, 2011-2015.

BackgroundHigh out‐of‐pocket (OOP) expenditure and inadequate insurance coverage may adversely affect cancer survivors. We aimed to characterize the extent and correlates of healthcare utilization, OOP expenditures, and underinsurance among insured cancer survivors.MethodsWe used 2011–2015 Medical Expenditure Panel Survey data to identify a nationally representative sample of insured non‐elderly adult (age 18–64 years) cancer survivors. We used negative binomial, two‐part (logistic and Generalized Linear Model with log link and gamma distribution), and logistic regression models to quantify healthcare utilization, OOP expenditures, and underinsurance, respectively, and identified sociodemographic correlates for each outcome.ResultsWe identified 2738 insured non‐elderly cancer survivors. Adjusted average utilization of ambulatory, non‐ambulatory, prescription medication, and dental services was 14.4, 0.51, 24.9, and 1.4 events per person per year, respectively. Higher ambulatory and dental services utilization were observed in older adults, females, non‐Hispanic Whites, survivors with a college degree and high income, compared to their counterparts. Nearly all (97.7%) survivors had some OOP expenditures, with a mean adjusted OOP expenditure of $1552 per person per year. Adjusted mean OOP expenditures for ambulatory, non‐ambulatory, prescription medication, dental, and other health services were $653, $161, $428, $194, and $83, respectively. Sociodemographic variations in service‐specific OOP expenditures were generally consistent with respective utilization patterns. Overall, 8.8% of the survivors were underinsured.ConclusionMany insured non‐elderly cancer survivors allocate a substantial portion of their OOP expenditure for healthcare‐related services and experience financial vulnerability, resulting in nearly 8.8% of the survivors being underinsured. Utilization of healthcare services varies across sociodemographic groups.

Overeaters Anonymous: An Overlooked Intervention for Binge Eating Disorder.

The purpose of this communication is to provide an overview as well as the strengths and weaknesses of Overeaters Anonymous (OA) as an intervention for binge eating disorder treatment. Binge eating disorder is associated with low remission rates, high relapse rates, treatment dissatisfaction, and high rates of failure to receive treatment attributed to stigma, misconceptions, lack of diagnosis, access to care, and inadequate insurance coverage. New interventions are needed that can overcome these barriers. OA is a twelve-step program and established fellowship for individuals who self-identify as having problematic relationships with food or eating. OA can be referred clinically or sought out by an individual confidentially, without a diagnosis, and free of charge. OA’s Nine Tools, Twelve Steps, and Twelve Traditions can provide structure, social support, and open, anonymous sharing that fosters a sense of connection and belonging. This may provide benefit to individuals who value structure and social support in their recovery. The tradition of anonymity may also create some challenges for conducting research and may explain the shortage of empirical support. This commentary reviews existing research findings on the effectiveness of twelve-step interventions and OA. Common misunderstandings about and within OA are also addressed and OA’s limitations are discussed. Overall, OA provides a promising option for binge eating disorder treatment that warrants clinical research on its feasibility and efficacy in a way that respects and protects its tradition of anonymity.

Health Insurance Access Among US Citizen Children In Mexico: National And Transborder Policy Implications.

More than 500,000 US citizen migrant children were residing in Mexico in 2015, and more than half of them had limited, inadequate health insurance despite their citizenship status. The majority of these children lived in Mexican states near the US border. Despite these numbers, knowledge regarding these children and their health has been scarce. To address these knowledge gaps, we analyzed data from the 2015 Mexican Intercensal Survey to examine whether the health insurance status of US citizen migrant children in Mexico is linked to individual, household, and state factors. We compared rates of insured US citizen migrant children with rates among those who were underinsured. We found high rates of underinsurance among US citizen migrant children, especially in northern Mexican border states. Parental education, labor-force participation, urban residence, and border residence partially accounted for these children's probability of being insured. Our results have implications for binational policies that extend health care protection to US citizen migrant children through reintegration assistance for their parents, an expedited dual-citizenship application process, and exempting these children from the automatic cancellation of US-based health benefits.

COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January–June 2020, in the United States

Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.

Financial distress and COVID-19: evidence from working individuals in India

PurposeThis study aims to explore the impact of the containment measures during COVID-19 on individuals’ finances, financial resilience during such distress and identifying the most financially vulnerable among them. Tracing such impact during the pandemic has been challenging due to a lack of representative data. This paper addresses this gap in the present study.Design/methodology/approachA survey has been conducted using a structured questionnaire containing various items that portray the impact on income, spending, saving, investment, borrowing, insurance and retirement. The sample consists of 699 respondents and purposive and snowball sampling has been used for data collection. The results are presented and analyzed using infographics and frequency distributions. This study conducts an analysis of variance and Chi-square tests for significance.FindingsThis paper finds a fall in income and limited ability to cope with the current economic conditions. The survey highlights inadequate savings and insurance, weak retirement planning, outstanding loans and under-diversified investments inhibiting financial resilience even among the higher-income group. Particularly, lower-income strata, women and not much educated are most financially vulnerable. Further, no substantial financial benefits have been received from the government and people rely on their usual income sources.Originality/valueTo the best of the authors’ knowledge, this is the first study that measures the pandemic’s impact on personal finances, especially in connection with a developing economy like India. Policy interventions are critical to the millions for whom financial literacy is required now more than ever.

Urban-Sensitive Social Protection: How Universalized Social Protection Can Reduce Urban Vulnerabilities Post COVID-19

Experience with urban social protection programmes is relatively limited in the Global South. Extensions or duplicates of rural social assistance programmes do not reflect the distinct vulnerabilities of the urban poor, who face higher living costs and more precarious employment, and are not reached by social insurance schemes that are designed for formally employed workers. Neither the Sustainable Development Goals nor the New Urban Agenda reflect a specific focus on urban social protection. COVID-19 has exposed this major gap in coverage, given the disproportionate impact of lockdowns on the livelihoods of the urban poor. To ‘build back better’ post COVID-19, we propose rights-based national social protection systems with two components: categorical social assistance for non-working vulnerable groups (children, older persons, persons with disability) and universal social insurance for all working adults (formal, informal or self-employed), financed out of general revenues rather than mandatory contributions by employees and employers. These ideas are explored in the case of South Africa, which has comprehensive social assistance but inadequate social insurance for urban informal workers.

541-P: Social and Biological Risk Factors Threaten Hispanics/Latinos with Type 2 Diabetes, Now at Risk for COVID-19

Hispanics/Latinos have disproportionately poor health outcomes from type 2 diabetes (T2D) and now emerging health threats like COVID-19. Mil Familias is a longitudinal observational cohort study enrolling Hispanic/Latino families with T2D, building a unique real-world dataset of genetic, biological, behavioral, psychosocial, and environmental determinants of health. This analysis showed that this cohort has biological and social risk factors for poor health outcomes from diabetes and emerging health threats.Interim analyses were conducted on the first 158 enrollees (64% female, age 57.6 years, 129 with T2D). In T2D subjects, sub-optimal glycemic control, obesity and uncontrolled blood pressure were common, increasing risk from T2D and COVID-19. Further, validated assessments of social determinants of health reveal inadequate health insurance coverage and low levels of: income, educational attainment, acculturation, trust in physicians, and confidence in their literacy-numeracy skills.Hispanic/Latino adults, especially women, with T2D in the Mil Familias cohort have a cluster of social as well as biological risk factors that make them vulnerable from T2D and new threats like COVID-19. The novel Mil Familias dataset sheds timely light on important social as well as biological risk factors for both communicable and non-communicable disease.View largeDownload slideView largeDownload slide DisclosureN. M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. R. Paczkowski: Employee; Self; Eli Lilly and Company, Employee; Spouse/Partner; Amgen Inc., Stock/Shareholder; Self; Eli Lilly and Company, Stock/Shareholder; Spouse/Partner; Amgen Inc. A. J. Larez: Research Support; Self; Abbott, Eli Lilly and Company. F. Gelsey: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. B. Yang: Research Support; Self; Abbott, Eli Lilly and Company. B. D. Benneyworth: Employee; Self; Eli Lilly and Company. D. Kerr: Advisory Panel; Self; Novo Nordisk, Sanofi-Aventis, Research Support; Self; Abbott Diabetes, Elsevier, Lilly Diabetes, Stock/Shareholder; Self; Glooko, Inc.

Inadequate Insurance Claims Reserving and Financial Distress in Non-Life Insurance Companies in Kenya: A Structural Equation Modeling Approach

Financial distress (FD) is a common occurrence in Kenyan commercial sector and is not lacking in non-life insurance companies in Kenya. Several insurance companies have been placed under statutory management for failure to pay genuine claims and other creditors. Insurance companies provide unique financial services, not only to individuals but also to the growth and development of the economy; giving employment to workers and dividends to investors. Financial distress places insurable properties and businesses at risk thus reducing the general public confidence in the insurance sector. For this paper, the goal was to investigate whether inadequate reserving of claims (IRC) causes financial distress in non-life insurance companies in Kenya. In accounting for insurance claims reserves, increases in reserves mean a reduction of profitability of an insurer, whereas a decrease in reserves increases the profitability resulting in higher taxation and payment of dividends, which drains the insurer’s cash flow, thus causing financial distress. Out of 37 non-life insurance companies, registered in 2018 in Kenya, four insurers were subjected to Pilot Testing and another four companies declined to participate in the survey. Secondary data from Insurance Regulatory Authority website was retrieved for calculations of Z-scores as per Altman (1993), amended formula. Primary data was also collected through a questionnaire. A partial least squares Structural Equation Modelling (PLS-SEM) was employed to assess the mediating effect of Insurance Regulatory Association (IRA) supervision on the association between inadequate reserving of claims and financial distress. Goodness-of-fit (GoF) indices were used to assess the model’s goodness of fit. By using the discriminative Z-score formula, 52% of the institutions considered in 2018 were financially distressed, compared to 48% in 2017. However, when considering the average of ten years (2009 to 2018), financially distressed Keywords: Non-life insurance companies, Policyholders, Insurance Regulatory Authority, Claims Reserving, Z-Scores, Structural Equation Modelling DOI: 10.7176/RJFA/12-12-06 Publication date: June 30 th 2021

574-P: GoFundMe Isn’t a Medical Plan

The rising cost of insulin, costly insurance premiums and the popularity of high deductible insurance plans have resulted in decreased access to insulin. People with diabetes who need financial support for insulin turn to crowdfunding websites, such as GoFundMe, to raise funds. It is unknown if crowdfunding is successful in funding insulin campaigns. This study aims to explore the success and contributing factors for crowdfunding insulin requests in the United States (US). In this retrospective, descriptive study, data were extracted from GoFundMe insulin campaigns for human use in the US from February to April 2019. Data were coded for the following characteristics: campaign requestor, the reason for the request, facial recognition age, gender and race, education level of the post (Flesch-Kincaid), diabetes type, insurance status, disability status, and previous request for pharma support. Descriptive statistics and chi-square tests were utilized to describe and analyze the campaign requestor, purpose and success rate, and contributing factors to campaign success. Of 205 GoFundMe campaigns, 114 (55.0%) were started by the person with diabetes (as opposed to family/friends). Campaigns were created due to insurance issues (i.e., loss of insurance, inadequate insurance coverage; N=125, 61.0%) and requested a median of $1,100 ($50-$200,000), and raised a median of $65 ($0-$6,920). A mean of 29.5% (± 0.6%) of the requested campaign amounts were met. There were no differences in funded status by the characteristics tested. Those who requested lower amounts of money <$500 were more likely to achieve funding X2(1, N=205) = 9.6, p<.01. Despite crowdfunding websites being used to augment insulin purchases, campaigns raise only a fraction of the money requested. Generally, crowdsourcing for insulin is not successful. Diabetes providers should routinely assess their patients’ ability to access insulin and provide resources as needed. People with diabetes must understand the limited success of crowdfunding insulin online. Disclosure J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. M. Tran: None. E. Iacob: None. T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. E. Grigorian: None. L. S. Edelman: None. M. L. Litchman: Research Support; Self; Abbott Diabetes.

Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration.

Primary care providers were assessed regarding their training and interest to screen oral conditions in patients ≥55years old. Oral health (OH) is an essential component of overall health and can affect systemic health. Medical/dental integration in older adults is underdeveloped. A brief survey assessed primary care providers' self-reported skills, practices and barriers towards integrating OH screening into adult primary care. Data were collected using Survey Monkey® . Respondents were physicians and advanced practice providers (APPs) working at a large mid-western safety-net hospital. Descriptive statistics, T-tests and Chi-squared tests were reported. Eighty-two of 202 participants (41%) completed the survey. Most respondents were female (75%). A majority were physicians (68%); the remainder APPs. All providers (100%) reported OH was important or extremely important to overall health. More physicians (93%) reported not being well-trained to address adult OH issues and perceived less medical-oral health integration in their practice (16%) compared to APPs (P<.05). Time was more of a barrier with APPs (74%), compared to physicians (51%), to integrate OH screening activities (P<.05). Most providers reported other barriers such as inadequate OH training and insurance coverage. Providers endorsed that OH should be assessed frequently (56%) including providing referrals to dentists (77%) and educating patients on oral-systemic issues (63%). More female than male providers endorsed dental referrals and educating patients (P<.05). Primary care providers embraced greater medical/dental integration for older adults. Instituting OH activities appears to be supported. Future interventions that are feasible in primary care settings are examined.

Effects of inadequate coverage on healthcare utilization: A regression discontinuity analysis.

To examine the impact of inadequate health insurance coverage on physician utilization among older adults using a novel quasi-experimental design in the time period following the elimination of cost sharing for most preventative services under the US Affordable Care Act of 2010.The Medical Expenditure Panel Survey full year consolidated data files for the period 2010 to 2017 were used to construct a pooled cross-sectional dataset of adults aged 60 to 70. Regression discontinuity design was used to estimate the impact of transitioning between non-Medicare and Medicare plans on use of routine office-based physician visits and emergency room visits.For the overall population, gaining access to Medicare at age 65 is associated with a higher propensity to make routine office-based visits (2.94 percentage points [pp]; P < .01) and lower out-of-pocket costs (−23.86 pp; P < .01) Similarly, disenrollment from non-Medicare insurance plans at age 66 was associated with more routine office-based visits (3.01 pp; P < .01) and less out-of-pocket costs (−8.09 pp; P < .10). However, some minority groups reported no changes in visits and out-of-pocket costs or reported an increased propensity to make emergency department visits.Enrollment into Medicare from non-Medicare insurance plans was associated with increased use of routine office-based services and lower out-of-pocket costs. However, some subgroups reported no changes in routine visits or costs or an increased propensity to make emergency department visits. These findings suggest other nonfinancial, structural barriers may exist that limit patient's ability to access routine services.