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Medicare insures 1.7 million reproductive-aged females living with a disability but does not cover contraception for pregnancy prevention. National survey data estimate 45.3% of disabled women use contraception; however, contraceptive use among disabled Medicare enrollees is unknown. We examine Medicare-reimbursed contraceptive use and enrollee characteristics associated with use.
From the Medicare enrollee file, we identified females aged 20–49 from 2017 to 2019, excluding dual-Medicaid enrollees. We identified any contraceptive use (pill, patch, ring, injectable, implant, intrauterine device (IUD), and sterilization) from inpatient, outpatient, and pharmacy claims using drug and procedure codes. We estimated the predicted probability of contraceptive use by enrollee characteristics using age-adjusted logistic regression.
Of 895,468 enrollees, 3.5% had Medicare-reimbursed contraception. Contraceptive users were slightly younger than non-users (35.1 ± 8.0 vs. 40.4 ± 7.4). Enrollees living in New England (4.8%; [95% CI, 4.6–5.0]) and East South-Central regions (3.1%; 95% CI, [2.9–3.2]) had the highest and lowest probability of contraceptive use, respectively. Indigenous (4.5%; 95% CI, [4.1–4.9]), Black (3.7%; 95% CI, [3.6–3.8]), and White (3.5%; 95% CI, [3.5–3.6]) enrollees were most likely, while Hispanic (2.8%; 95% CI, [2.7–2.9]), and Asian (2.7%; 95% CI, [2.5–3.0]) enrollees were least likely to use contraception. People with both a physical and cognitive disability had a slightly higher probability of contraceptive use (4.3%; 95% CI, [4.2–4.4]), than those with cognitive (4.0%; [95% CI, 3.9–4.1]) or physical (3.5%; 95% CI, [3.4–3.6]) disability alone.
We found a considerable gap in contraceptive use among Medicare enrollees relative to national estimates of self-reported use (3.5% vs. 45.3%). Understanding who is and is not using Medicare-reimbursed contraception is critical, as people with disabilities already experience substantial barriers to reproductive healthcare.
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© 2022 Published by Elsevier Inc.