Disabled are falling through gaps in Medicare coverage

Without supplemental coverage, many beneficiaries with disabilities can't afford needed care.

By Markian Hawryluk, AMNews staff. Jan. 12, 2004.

Washington -- Reatha Jenson, a former truck driver from Samson, Ala., is a Medicare beneficiary. But don't call her a senior just yet. The 60-year-old is one of about 5 million Medicare beneficiaries who qualify for Medicare by virtue of a disability, rather than age.

Eight years ago, Jenson fell while cleaning her truck and struck her head on a steel beam. The accident caused nerve damage in her arms and legs. Unable to work, she waited two years to qualify for Medicare, which helps pay for her doctor's visits, oxygen and a nebulizer. But she must still find the money for prescription drugs and the cost sharing required by Medicare.

"I don't go lots of times when I need to go because I know I can't pay for it, and even if I could pay the doctor, how would I buy the medicine?" Jenson said. "Why go to the doctor if you can't pick up the medicine that he's prescribed you? That's a waste of your time."

A survey conducted by the Kaiser Family Foundation found that Jenson's story is not unique. Although Medicare provides access to health care services for the elderly and disabled, it requires beneficiaries to share some of the cost burden. Many cannot afford to pay their portion and as a result go without needed health services or products. Activists charge that the latest Medicare reform efforts continue to treat disabled beneficiaries as a forgotten population.

Disabled beneficiaries have higher average costs than seniors but lower average incomes. Studies have shown that disabled beneficiaries are twice as likely as seniors to live under the federal poverty level, yet spend 40% to 50% more for prescription drugs and are almost twice as likely to spend at least 10% of their income on health care costs.