Awareness of the Medicare Part D Low-Income Subsidy Among Older Non-Hispanic Blacks and Hispanics

Background and Purpose:  Medicare Part D went into effect in 2006 and increased access medications through its creation of a prescription drug benefit.  A key provision of Medicare Part D is the Low-Income Subsidy (LIS) program, which was designed to reduce cost sharing associated with Part D for vulnerable populations.  Beneficiaries whose income is below 150% of the federal poverty level can apply for assistance under the LIS program. Despite the availability of the LIS, only two-thirds of eligible beneficiaries participate.  A primary barrier to uptake of this benefit is lack of awareness. While evidence suggests race and ethnicity can be predisposing factors that impact access to health insurance benefits, it is unclear whether disparities in awareness of the LIS exist.  Using Andersen’s Behavioral Model of Health Services Use, this study sought to understand the relationship between race, ethnicity, and LIS awareness.

Methods:  Nationally representative data from the 2010 wave of Health and Retirement Study were used to evaluate awareness of the Medicare Part D LIS. The analytic sample consisted of 1,268 respondents age 65 and older that were enrolled in Medicare Part D and whose income met the LIS eligible criteria. The outcome variable of interest was awareness of the LIS. The main predictors were race (non-Hispanic Black and non-Hispanic White) and ethnicity (Hispanic). Covariates were chosen based on factors that can predict prescription drug utilization and included demographics, socioeconomic status, health status, and number of prescribed medications. The analysis was conducted using multivariate logistic regression.

Results:  After controlling for predictors of prescription drug utilization, results indicated that older non-Hispanic Blacks were 57 percent less likely to be aware of the LIS than non-Hispanic Whites (p<.05).  Older Hispanics’ likelihood of having knowledge of the LIS was 64 percent lower than non-Hispanic Whites (P<.01).  Further, individuals in poorer health were less likely to report knowledge of the LIS than those in excellent health (p<.05).

Conclusions and Implications: Findings suggest that older non-Hispanic Blacks and Hispanics may be less likely to take advantage of the LIS due to their lack of awareness.  This is concerning, particularly given racial and ethnic differences in cost-related adherence to medications.  To increase awareness, social work practitioners should consider educating older non-Hispanic Blacks and Hispanics about the LIS benefit during the assessment process. Further, understanding that differentials in awareness exist is critical when evaluating policy alternatives in order to promote more equitable access to the benefit.