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Objectives
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.
Methods
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.
Results
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.
Conclusions
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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Copyright
© 2022 Published by Elsevier Inc.
