• McKayla Massey, Kathryn Litten, Samuel D Towne, Vasiliki Beleri, Chanhyun Park, and Boon Peng Ng.
• College of Medicine, University of Central Florida, Orlando, Florida, USA.
• J Eval Clin Pract. 2025 Feb 1; 31 (1): e14290e14290.

Aims And ObjectivesApproximately 50% of Americans report having low health insurance literacy, leading to uncertainty when choosing their insurance coverage to best meet their healthcare needs. Therefore, we aimed to evaluate the association between lack of prescription drug benefit knowledge and problems paying medical bills among Medicare beneficiaries.MethodsWe analysed the 2021 Medicare Current Beneficiary Survey Public Use File of 5586 Medicare beneficiaries aged ≥ 65 years. The binary dependent variable was whether beneficiaries had problems paying medical bills in the past year. The categorical independent variable was how much beneficiaries knew about the Medicare prescription drug benefit. A survey-weighted multivariable logit model, adjusted for covariates (e.g., socio-demographics, comorbidities, private insurance coverage, and satisfaction with out-of-pocket costs), was conducted to examine the association between the independent variable and problems paying medical bills.ResultsApproximately 4.3% of study beneficiaries (~2.0 million beneficiaries) reported problems paying medical bills. Of those without and with problems paying medical bills, 27.7% and 39.6%, respectively, reported knowing little/almost nothing about prescription drug benefits. Beneficiaries aged 65-74 years (marginal effect [ME] = 2.1%, p < 0.01), with comorbidities (e.g., ≥ 4 conditions, ME = 3.8%, p < 0.001), dissatisfaction with out-of-pocket costs (ME = 10.1%, p < 0.001), without private insurance (e.g., employer-sponsored insurance, ME = 2.5%, p < 0.01), or with little/almost no knowledge of prescription drug benefits (ME = 1.9%, p < 0.05) were more likely to report problems paying medical bills compared to their counterparts.ConclusionTailored programmes aimed at improving beneficiaries' knowledge of prescription drug benefits, reducing out-of-pocket costs and preventing comorbidities may be considered for the at-risk population to address the problem.© 2024 John Wiley & Sons Ltd.

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