Coverage Gaps and Contraceptive Use Among Medicare Enrollees With Disabilities.

Area of Science:

• Public Health
• Health Services Research
• Reproductive Health

Background:

• Medicare insures 1.5 million reproductive-aged women with disabilities.
• Unlike other major US health insurers, Medicare is not mandated to cover contraceptives for pregnancy prevention.
• This creates potential coverage gaps for beneficiaries with disabilities.

Purpose of the Study:

• To investigate the association between Medicare's contraceptive coverage gaps and reduced contraceptive use among disabled enrollees.
• To evaluate the impact of gaining contraceptive coverage through dual Medicare-Medicaid enrollment on contraceptive utilization.

Main Methods:

• A national, cross-sectional study analyzing Medicare and Medicaid claims data from 2016-2020.
• Included female enrollees aged 20-49 receiving disability benefits (SSDI/SSI).
• Used propensity score weighting and a difference-in-differences design to assess the impact of dual enrollment on contraceptive use.

Main Results:

• Analysis included over 51 million monthly observations from 1.6 million women.
• Contraceptive use probability was lowest for Traditional Medicare (TM) and Medicare Advantage (MA) enrollees.
• Gaining dual Medicare-Medicaid coverage was linked to a 3.9 percentage point increase in any contraceptive method use (35% increase).

Conclusions:

• Medicare's contraceptive coverage gaps present a financial barrier to desired contraceptive use for disabled enrollees.
• Dual Medicare-Medicaid enrollment significantly increased contraceptive use, particularly short-acting methods.
• Medicare should be mandated to cover all FDA-approved contraceptives without cost-sharing to align with other major insurers.