Trends in Rehabilitation Insurance Benefit Exhaustion Among Older Adults in the United States and Associations With Racial Identity.

IMPORTANCE

Rehabilitation supports independence for older adults with disability, but limitations in access to services and the amount of care received are ongoing concerns. One potential driver is insurance coverage.

OBJECTIVE

This study characterized trends and racial disparities in rehabilitation insurance benefit exhaustion among older adults from 2015 to 2022.

DESIGN

The study was a repeated cross-sectional analysis using data from the National Health and Aging Trends Study (NHATS). Models were clustered at the patient level to estimate changes in insurance exhaustion from 2015 to 2022, and an overall estimate of racial disparities over this time period was estimated using survey-weighted logistic regression.

SETTING

Population-based survey of patients in rehabilitation facilities and clinics in the United States.

PARTICIPANTS

The sample included 5653 rehabilitation user-years (weighted N = 38.3 million) contributed by 3386 community-dwelling Medicare beneficiaries aged 70+ who received rehabilitation services between 2015 and 2022.

EXPOSURES: The primary exposure of interest was racial and ethnic identity, categorized as Non-Hispanic Black and Non-Hispanic White.

MAIN OUTCOME AND MEASURES: The main outcome was patient-reported rehabilitation insurance benefit exhaustion, defined using NHATS survey responses.

RESULTS

From 2015 to 2022, the overall rate of patient-reported rehabilitation insurance benefit exhaustion among older adults declined from 32.0% (95% CI = 28.1%-35.7%) to 27.9% (95% CI = 24.4%-31.3%). However, racial disparities persisted and widened over this period. In 2015, 39.2% (95% CI = 29.7%-48.8%) of Black older adults reported benefit exhaustion compared to 30.7% (95% CI = 26.3%-35.0%) of White older adults. By 2022, rates declined to 25.7% (95% CI = 21.6%-29.8%) among White adults and 38.5% (95% CI = 27.4%-49.5%) among Black adults. In adjusted analyses, the odds of patient-reported rehabilitation insurance benefit exhaustion were higher for Black versus White adults from 2015 to 2022 (OR = 1.50; 95% CI = 1.20-1.86).

CONCLUSIONS

Although overall rates of patient-reported rehabilitation insurance benefit exhaustion declined modestly from 2015 to 2022, 1 in 4 still reported terminating their rehabilitation episodes because of self-reported insurance benefit exhaustion in 2022 with growing racial disparities over time.

RELEVANCE: These findings highlight the need for Medicare reforms that expand and equitably enforce coverage to ensure all older adults-particularly those from marginalized groups-can complete the rehabilitation necessary to maintain independence.