Does poorer familiarity with medicare translate into worse access to health care?

OBJECTIVES: To examine the relationship between a global measure of Medicare program familiarity and a broad set of measures of actual and perceived healthcare access. DESIGN: Mailed survey in fall of 2004 (2,997 completed surveys; 53% response rate). SETTING: Metropolitan and nonmetropolitan areas across the United States. PARTICIPANTS: White, black, and Hispanic Medicare beneficiaries. MEASUREMENTS: Familiarity with Medicare and self-reported measures of health status, healthcare use, and perceived access to care. RESULTS: Reported poorer familiarity with Medicare is associated with a greater likelihood of delayed care due to cost, multiple emergency department visits, lack of prescription medication use, poorer perceived access to care, poorer overall health, and a greater reported decline in health from the prior year. Black and Hispanic respondents were more likely to be unfamiliar than whites, although the relationship between familiarity and healthcare access persisted after adjusting for race or ethnicity, Medicare health plan enrollment status, supplemental insurance status, age, sex, income level, education, geographic area, and general healthcare use. CONCLUSION: Poorer familiarity with Medicare may affect beneficiaries' ability to access needed care effectively, may lead them to delay or avoid seeking care, and ultimately may have negatively affect the quality of the health care that they receive and their outcomes.