ArticlePhysical therapy2026
Trends in Rehabilitation Insurance Benefit Exhaustion Among Older Adults in the United States and Associations With Racial Identity.
Article in Physical therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
importanceRehabilitation supports independence for older adults with disability, but limitations in access to services and the amount of care received are ongoing concerns. One potential driver is insurance coverage.
objectiveThis study characterized trends and racial disparities in rehabilitation insurance benefit exhaustion among older adults from 2015 to 2022.
designThe study was a repeated cross-sectional analysis using data from the National Health and Aging Trends Study (NHATS). Models were clustered at the patient level to estimate changes in insurance exhaustion from 2015 to 2022, and an overall estimate of racial disparities over this time period was estimated using survey-weighted logistic regression.
settingPopulation-based survey of patients in rehabilitation facilities and clinics in the United States.
participantsThe sample included 5653 rehabilitation user-years (weighted N = 38.3 million) contributed by 3386 community-dwelling Medicare beneficiaries aged 70+ who received rehabilitation services between 2015 and 2022. EXPOSURES: The primary exposure of interest was racial and ethnic identity, categorized as Non-Hispanic Black and Non-Hispanic White. MAIN OUTCOME AND MEASURES: The main outcome was patient-reported rehabilitation insurance benefit exhaustion, defined using NHATS survey responses.
resultsFrom 2015 to 2022, the overall rate of patient-reported rehabilitation insurance benefit exhaustion among older adults declined from 32.0% (95% CI = 28.1%-35.7%) to 27.9% (95% CI = 24.4%-31.3%). However, racial disparities persisted and widened over this period. In 2015, 39.2% (95% CI = 29.7%-48.8%) of Black older adults reported benefit exhaustion compared to 30.7% (95% CI = 26.3%-35.0%) of White older adults. By 2022, rates declined to 25.7% (95% CI = 21.6%-29.8%) among White adults and 38.5% (95% CI = 27.4%-49.5%) among Black adults. In adjusted analyses, the odds of patient-reported rehabilitation insurance benefit exhaustion were higher for Black versus White adults from 2015 to 2022 (OR = 1.50; 95% CI = 1.20-1.86).
conclusionsAlthough overall rates of patient-reported rehabilitation insurance benefit exhaustion declined modestly from 2015 to 2022, 1 in 4 still reported terminating their rehabilitation episodes because of self-reported insurance benefit exhaustion in 2022 with growing racial disparities over time. RELEVANCE: These findings highlight the need for Medicare reforms that expand and equitably enforce coverage to ensure all older adults-particularly those from marginalized groups-can complete the rehabilitation necessary to maintain independence.
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