Younger Medicare Beneficiaries Without Supplemental Coverage Face Increased Barriers to Care: Emma Achola-Kothari, PhD

In part 1 of an interview with Emma Achola-Kothari, PhD, lead investigator of "Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years," a study published in the May 2025 issue of The American Journal of Managed Care®, she shares the inspiration behind the study and provides an overview of the key findings.

Earlier this month, Achola-Kothari earned her PhD in health policy and health services research from Vanderbilt University.

This transcript was lightly edited; captions were auto-generated.

Transcript

Prior to your study, what was known about the experiences of Medicare beneficiaries under the age of 65? What gaps in the literature were you aiming to address?

Prior to us setting out to do this work, there were a few other published studies that looked at self-reported experiences of care amongst the population of Medicare beneficiaries under [the age of] 65. There were some papers that looked at perceptions of care, like, how do you like the Medicare program?

I think, [with] our paper, we wanted to add to that literature. Like I said, there is some work out there, there's not a ton, especially if you compare it with the wealth of literature that is focused on the over-65 population.

I think we wanted to add another dimension by looking at how having access to supplemental coverage affects cost and access measures, as well as the angle of looking at it by dual-eligibility status, since duals do have some level of wraparound coverage with Medicaid that the Medicare-only population doesn't have. That's what we were hoping to do, and use a different data source, as well, to add to the body of literature on this population of beneficiaries.

Can you discuss the main findings? Were there any that surprised you?

Top of the line, our findings showed beneficiaries who were in traditional Medicare with no financial protections from out-of-pocket costs. Whether that be the out-of-pocket maximums that are provided to you in Medicare Advantage, or because you've purchased a supplement, or you have some level of supplemental coverage, the beneficiaries who don't have access to that wraparound care or those financial protections, we did see that there was an increase in people or inbeneficiaries reporting financial and access barriers to care. Interestingly, when we break it out by dual-eligibility status, we see that those associations go away when we look specifically at dual-eligible beneficiaries.