Medicare Resource Use Differs by English Reading Proficiency

Medicare coverage decisions are complex. The Centers for Medicare & Medicaid Services (CMS) provides a hotline, handbook, and website to help Medicare beneficiaries understand their benefits and coverage options, yet it is unclear what factors affect beneficiary use of these resources. We examined limited English speaking and English reading proficiency status as predictors of CMS Medicare informational resource use in a nationally representative sample of Medicare beneficiaries.

We used 2016-2018 Medicare Current Beneficiary Survey data and linear probability models to assess whether the likelihood of using CMS Medicare informational resources differed among beneficiaries with limited English proficiency. We adjusted models for demographic, socioeconomic, health, and local market factors and, in sensitivity analyses, health insurance characteristics. Our primary outcome was an indicator of having previously used at least 1 of the 3 CMS resources.

Among noninstitutionalized beneficiaries (n = 20 715), 4.8% had limited English speaking proficiency, 7.0% had limited English reading proficiency, and 67.7% had used at least 1 CMS resource. After regression adjustment, beneficiaries with limited English reading proficiency were 16.3 percentage points less likely to have used a CMS resource compared to beneficiaries who reported English reading proficiency (p < .001). Limited English speaking proficiency was not associated with CMS resource use.

These findings suggest that English reading proficiency may be an underappreciated factor in Medicare beneficiaries' use of the Medicare handbook, hotline, and website. Alternative approaches to providing and publicizing informational resources may reduce barriers to Medicare resource use among beneficiaries with limited English reading proficiency.