Medicare eligibility is tied to better health in LGBTQI+ adults compared to heterosexual adults. In states with more preexisting sexual disparities, the federal health program may lower insurance disparities and access to care in sexual minorities, according to a July 5 study in JAMA Health Forum.
Researchers conducted the study to find out how Medicare affects care access, disparities in health insurance coverage and health status based on people’s sexual orientation and gender identity. Data came from the Behavioral Risk Factor Surveillance System, which included 927,952 participants ages 51 to 79 years old from 2014 to 2021. The average age of participants was 64.4 years old, and 56.6% were female. Of all participants, 3.03% identified as a sexual minority (lesbian, gay, bisexual, or another sexual minority identity) and 0.35% were transgender or gender diverse.
People who identified as heterosexual had better improvements in insurance coverage at age 65 compared to sexual minorities. There were better improvements in usual sources of care, cost barriers to care and influenza vaccination in heterosexual participants compared to sexual minorities at 65. In terms of how people self-reported on their health, there were larger improvements at age 65 years for sexual minorities over heterosexual respondents.
There was substantial diversity by state in disparities by sexual orientation among people who were close to 65 (and therefore close to being eligible for Medicare). States in the South and Central part of the United States had the highest disparities. Among the top 10 states with the highest disparities, Medicare eligibility was associated with greater increases in coverage (by 6.7 percentage points in sexual minorities. That compares to 5 percentage points in heterosexual individuals), and access to a usual source of care was at 1.4 percentage points in sexual minorities compared to 0.6 percentage points in people who were heterosexual.
“The findings of this cross-sectional study indicate that Medicare eligibility was not associated with consistently greater improvements in health insurance coverage and access to care among LGBTQI+ individuals compared with heterosexual and/or cisgender individuals,” the authors wrote. “However, among sexual minority individuals, Medicare may be associated with closing gaps in self-reported health status, and among states with the highest disparities, it may improve health insurance coverage, access to care, and self-reported health status.”
