Duration of health insurance coverage gaps and subsequent cost-related barriers to care among adults aged 18-64 years with multimorbidity.

OBJECTIVES

To examine whether health insurance coverage-gap duration predicts subsequent cost-related barriers to care among working-age adults with multimorbidity.

METHODS

We pooled Medical Expenditure Panel Survey Panels 23 and 24, identifying 1,694 adults aged 18-64 years with at least two of nine chronic physical condition groups at baseline. Uninsured months during Years 1-2 were categorized as 0, 1-5, 6-23, or 24. The outcome was any cost-related delay in or inability to obtain medical care or prescription medicines during Years 3-4. Survey-weighted logistic regression accounted for weights, strata, primary sampling units, domain analysis, and Taylor-series linearization. Sensitivity analyses examined categorical age, insurance-source patterns, and cancer exclusion. Constant 2022 US-dollar expenditures were summarized using weighted medians and interquartile ranges and analyzed using two-part models with survey-aware jackknife confidence intervals for standardized means.

RESULTS

Among 1,694 participants, 379 experienced the outcome. Compared with no gap, adjusted odds ratios were 1.61 (95% CI, 0.94-2.77) for 1-5 uninsured months, 2.06 (95% CI, 1.17-3.63) for 6-23 months, and 3.44 (95% CI, 1.84-6.44) for 24 months; adjusted probabilities were 17.4, 24.8, 29.3, and 39.8%, respectively. Findings were robust to categorical age adjustment and cancer exclusion. Only continuous uninsurance was significantly associated with the outcome relative to continuous private coverage. For continuous uninsurance versus no gap, weighted median total expenditures were $1,235 versus $9,378, and median out-of-pocket expenditures were $464 versus $944. Adjusted total expenditures were lower ($4,884 vs. $26,134; ratio, 0.19; p < 0.001), whereas adjusted out-of-pocket expenditures did not differ significantly ($2,632 vs. $2,229; ratio, 1.18; p = 0.422).

CONCLUSION

Longer coverage gaps were associated with greater subsequent cost-related barriers. Lower total spending without significantly lower out-of-pocket spending among continuously uninsured adults suggests foregone or reduced care rather than improved financial protection.