Table 2.
Adjusted Associations Between Medicare Advantage Plan Choice and Health Literacy (N = 311)
| Medium Cost, Medium Coverage vs. Higher Premium, More Coverage (Plan A vs. Plan C) | Lower Premium, Less Coverage vs. Higher Premium, More Coverage (Plan B vs. Plan C) | |
|---|---|---|
|
| ||
| Variable | Relative Risk [95% CI] | |
|
| ||
| Education | ||
| Less than high school | 1.44 [0.65, 3.21] | 1.19 [0.31, 4.54] |
| High school | 1.58 [0.48, 5.24] | 0.17* [0.02, 1.24] |
| >High school | — | — |
|
| ||
| Monthly income | ||
| Low income (≤$2,000) | 1.06 [0.49, 2.29] | 1.26 [0.37, 4.34] |
| High income (>$2,000) | — | — |
|
| ||
| Insurance | ||
| Medicare FFS | 0.82 [0.31, 2.18] | 0.33 [0.06, 1.73] |
| Medicare Advantage | — | — |
| Supplemental prescription | 0.78 [0.36, 1.71] | 0.16** [0.03, 0.93] |
| Supplement (MediGap) | 1.36 [0.35, 5.33] | 0.24 [0.01, 4.35] |
| Other | 0.53 [0.15, 1.90] | 0.63 [0.11, 3.74] |
|
| ||
| Health status | ||
| Excellent/very good | — | — |
| Good | 1.12 [0.48, 2.60] | 0.34 [0.09, 1.34] |
| Fair/poor | 1.2 [0.42, 3.44] | 0.98 [0.20, 4.76] |
|
| ||
| Chronic conditions | ||
| 0–1 | — | — |
| 2–3 | 0.85 [0.37, 1.95] | 1.36 [0.39, 4.74] |
| 4+ | 0.97 [0.34, 2.80] | 0.85 [0.14, 5.22] |
|
| ||
| Functional health status | ||
| Any IADL impairment | 1.93 [0.83, 4.48] | 1.7 [0.42, 6.88] |
| Any ADL impairment | 1.39 [0.63, 3.08] | 2.89 [0.77, 10.86] |
|
| ||
| Annual primary care visits | ||
| 0–1 | — | — |
| 2–3 | 2.17 [0.75, 6.30] | 0.67 [0.13, 3.42] |
| 4–5 | 1.05 [0.33, 3.28] | 0.76 [0.14, 4.08] |
| 6+ | 1.18 [0.32, 4.29] | 0.51 [0.06–4.54] |
|
| ||
| Annual specialty care visits | ||
| 0–3 | 1.57 [0.63, 3.95] | 2 [0.48, 8.36] |
| 4–8 | — | — |
| 9+ | 1.19 [0.57, 2.46] | 2.01 [0.52, 7.87] |
|
| ||
| Number of medications taken daily | ||
| 0–2 | — | |
| 3–6 | 1.1 [0.50, 2.43] | 1.63 [0.40, 6.58] |
| 7+ | 0.88 [0.31, 2.49] | 1.13 [0.16, 8.08] |
|
| ||
| Monthly medication costs | ||
| $0–$9 | — | — |
| $10–$49 | 0.84 [0.34, 2.05] | 0.54 [0.13, 2.21] |
| $50+ | 0.72 [0.26, 1.97] | 1.03 [0.22, 4.92] |
|
| ||
| Annual emergency department visits | ||
| 0–1 | — | — |
| 2–5 | 0.61 [0.30, 1.23] | 0.74 [0.22, 2.54] |
| 6+ | 0.57 [0.08, 4.00] | 7.25* [0.71, 73.62] |
|
| ||
| Annual admissions to hospital | ||
| 0–1 | — | — |
| 2–5 | 1.08 [0.46, 2.54] | 2.88* [0.88, 9.41] |
| 6+ | 5.18 [0.43, 61.83] | 0.01** [0.00, 0.01] |
|
| ||
| Difficulty paying health care costs | ||
| Not at all | — | — |
| Somewhat | 0.72 [0.31, 1.68] | 1.4 [0.37, 5.32] |
| Difficult | 2.51 [0.78, 8.03] | 2.3 [0.19, 27.20] |
| Very difficult | 1.44 [0.43, 4.86] | 3.5 [0.76,16.13] |
|
| ||
| Constant | 0.08*** [0.01, 0.60] | 0.02*** [0.00, 0.60] |
Note. Adjusted associations between health literacy and Medicare Advantage plan choice were estimated using multinomial logistic regression. Plan C is the comparison choice. ADL = activities of daily living; CI = confidence interval; FFS = fee for service; IADL = instrumental activities of daily living.
*
p < 0.1.
**
p < .05.
***
p < .01.