Quality of care for Medicare beneficiaries with disabilities under the age of 65 years.

Social Security Disability Insurance provides cash benefits to disabled workers and certain others under the age of 65 years. These individuals become eligible for Medicare 24 months after Social Security Disability Insurance cash benefits start. In 2001, 13.9% of Medicare's approximately 40 million beneficiaries were adults under the age of 65 years with disabilities, and they generated 15% of total program costs. Medicare beneficiaries with disabilities under the age of 65 years are much more likely than elderly beneficiaries to be minority race and ethnicity, impoverished, and to report fair or poor health. They are clinically diverse, with 53.4% reporting mental health conditions. Although Medicare provides essential coverage of acute medical services and selected rehabilitative and long-term care services, by law, Medicare does not reimburse important items and services essential to daily living for many people with disabilities, including mobility aids for use outside the home, physical and occupational therapy to maintain functioning or prevent declines, as well as personal assistance services. This gap represents a fundamental, structural quality problem for persons with disabilities. Surveys suggest that most Medicare beneficiaries with disabilities are generally satisfied with their standard medical services, but they report problems at much higher rates than elderly beneficiaries. Reforming Medicare to meet pressing needs of beneficiaries with disabilities will likely require statutory changes.