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The Effect of Depression and Cognitive Impairment on Enrollment in Medicare Part D

Authors

  • Kara Zivin PhD,

    1. From the *Serious Mental Illness Treatment Research and Evaluation Center and §Center for Practice Management and Outcomes Research, Health Services Research and Development Center of Excellence, Department of Veterans Affairs, Ann Arbor, MichiganDepartment of Psychiatry, Division of General Medicine, Department of Medicine, Medical School, and Institute for Social Research, University of Michigan, Ann Arbor, Michigan; and niversity of Michigan, Ann Arbor, Michigan.
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  • Mohammed U. Kabeto MS,

    1. From the *Serious Mental Illness Treatment Research and Evaluation Center and §Center for Practice Management and Outcomes Research, Health Services Research and Development Center of Excellence, Department of Veterans Affairs, Ann Arbor, MichiganDepartment of Psychiatry, Division of General Medicine, Department of Medicine, Medical School, and Institute for Social Research, University of Michigan, Ann Arbor, Michigan; and niversity of Michigan, Ann Arbor, Michigan.
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  • Helen C. Kales MD,

    1. From the *Serious Mental Illness Treatment Research and Evaluation Center and §Center for Practice Management and Outcomes Research, Health Services Research and Development Center of Excellence, Department of Veterans Affairs, Ann Arbor, MichiganDepartment of Psychiatry, Division of General Medicine, Department of Medicine, Medical School, and Institute for Social Research, University of Michigan, Ann Arbor, Michigan; and niversity of Michigan, Ann Arbor, Michigan.
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  • Kenneth M. Langa MD, PhD

    1. From the *Serious Mental Illness Treatment Research and Evaluation Center and §Center for Practice Management and Outcomes Research, Health Services Research and Development Center of Excellence, Department of Veterans Affairs, Ann Arbor, MichiganDepartment of Psychiatry, Division of General Medicine, Department of Medicine, Medical School, and Institute for Social Research, University of Michigan, Ann Arbor, Michigan; and niversity of Michigan, Ann Arbor, Michigan.
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Address correspondence to Kara Zivin, Department of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109. E-mail: kzivin@umich.edu

Abstract

OBJECTIVES: To examine concerns that vulnerable populations, such as depressed or cognitively impaired beneficiaries would have challenges accessing Part D coverage.

DESIGN: Logistic regression analysis was used to assess whether elderly Medicare beneficiaries with depression or cognitive impairment differentially planned to and actually signed up for Part D.

SETTING: 2004 and 2006 data from the Health and Retirement Study (HRS) were used, including a subsample that completed the Prescription Drug Study (PDS) in 2005.

PARTICIPANTS: Nine thousand five hundred ninety-three HRS respondents and 3,567 PDS respondents.

MEASUREMENTS: The outcome variables of interest were planned and actual enrollment in Part D. The independent variables were depression and cognitive impairment status. The analyses were adjusted using clinical and demographic predictors including age, sex, race or ethnicity, educational attainment, net worth, marital status, health status, number of health conditions being treated with prescription medications, and presence of a caregiver.

RESULTS: Although having depression or cognitive impairment was associated with a higher likelihood of planning to and actually signing up for Part D in unadjusted analyses, in adjusted analyses, having depression or cognitive impairment was not significantly associated with whether Medicare beneficiaries planned to enroll in or actually enrolled in Part D.

CONCLUSION: Vulnerable Medicare beneficiaries with depression or cognitive impairment were able to access Part D benefits to the same extent as nonvulnerable beneficiaries. More research is needed to determine how well Part D meets the needs of these populations.

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