The Relationship between Medicare Coverage and Financial Difficulty Among Caregivers of Older Adults

Background and Purpose: A recent study of caregiver financial strain in a convenience sample of caregivers for older adults found that caregivers with access to Medicare reported lower financial strain scores than those with any other type of health insurance (Greenfield, Hasche, Bell, & Johnson, 2018). This is an intriguing finding, especially as “Medicare-for-All” policy proposals are gaining new momentum in the U.S. Given increasing concern about the financial strain experienced by caregivers of older adults, identification of policies that may help mitigate financial strain is an important effort. Therefore, we sought to test the association of Medicare coverage with financial strain among a nationally representative sample of caregivers to see whether the original finding was generalizable to a national population.

Methods: Data come from three rounds of the National Study of Caregiving (NSOC) administered in conjunction with the National Health and Aging Trends Study (NHATS). NSOC I, II, and III are nationally representative studies of unpaid caregivers to older adults experiencing limitations in their daily activities. NSOC I (n = 2,007), NSOC II (n = 2,204), and NSOC III (n = 2,652) were administered in 2011, 2015, and 2017, respectively. Data were collected through telephone interviews with unpaid caregivers helping NHATS participants with daily activities. NSOC participants were asked about the types of support services they used, the types of activities they helped care recipients with, the effects of their caregiving experiences, and demographic information. Logistic regressions were used to examine the relationship between caregiver Medicare coverage status and caregiver experiences of financial difficulty related to their caregiving role for NSOC I, II, and III.

 Results: Thirty-nine percent (n = 785) of NSOC I participants reported that they had Medicare coverage and 23% (n = 459) reported that caregiving was financially difficult. Caregivers with Medicare coverage were 25% less likely to experience financial difficulty when compared to participants without Medicare coverage (p = .04). NSOC II participants reported higher rates of Medicare coverage (47%; n = 1,031) and lower rates of financial difficulty (18%; n = 398) than NSOC I participants. NSOC II participants with Medicare coverage were almost 34% less likely to experience financial difficulty than participants without Medicare coverage (p = .003). Forty-six percent (n = 1,227) of NSOC III participants reported that they had Medicare coverage and nearly 16% reported experiencing financial difficulty. While those with Medicare coverage were 7% less likely to experience financial difficulty related to their caregiving role than those without Medicare coverage, the finding was not statistically significant.

Conclusions and Implications: Overall, Medicare coverage and lower rates of financial difficulty were significantly associated in this nationally representative sample of caregivers of older adults. Interestingly, the association was most significant in the wave with the lowest average age, which suggests that extending coverage to those in lower age groups may help to offset the financial challenges that are often associated with caregiving. We will discuss how age, race, and gender influence these associations and assess implications for potential expansion of Medicare.