Understanding Medicare: Hearing Loss and Health Literacy

Medicare has become an increasingly complex program to navigate with numerous choices available to beneficiaries with important implications for their financial exposure and access to care. Although research has identified poor health literacy as a barrier to understanding Medicare, little information is available on the experience of individuals with hearing loss. This study examined how hearing loss impacts Medicare beneficiaries in understanding the program, their ability to compare and review plan options, and their satisfaction with available information.

Cross-sectional analysis using multivariate ordinal logistic regression.

Nationally representative survey of Medicare beneficiaries in the United States (Medicare Current Beneficiary Survey [MCBS]) 2017.

A total of 10,510 Medicare beneficiaries were analyzed, representing 50,084,169 beneficiaries with survey weights applied.

The primary outcome was difficulty understanding Medicare, determined by this MCBS question: "Overall, how easy or difficult do you think the Medicare program is to understand?" The predictor of interest was self-reported hearing loss measured categorically as no trouble, a little trouble, and a lot of trouble hearing. Covariates included age, sex, race, educational attainment, household income relative to the federal poverty level, enrollment in either traditional Medicare or Medicare Advantage, dementia diagnosis, trouble with vision, and number of chronic conditions.

Medicare beneficiaries with a little or a lot of trouble hearing had 18% (95% confidence interval [CI] odds ratio [OR] = 1.10-1.27) and 25% (95% CI OR = 1.07-1.47) increased odds of reporting greater difficulty with understanding Medicare, respectively, compared with those with no hearing trouble. About one in five Medicare beneficiaries with hearing loss identified that their hearing made it difficult to find Medicare information.

The existing tools to support Medicare beneficiaries' understanding and navigation of the program must evolve to meet the needs of those with hearing loss, a highly prevalent condition among Medicare beneficiaries. J Am Geriatr Soc 68:2336-2342, 2020.