{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:09:29Z","timestamp":1786975769296,"version":"build-2736575974"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Medicare is the primary health insurance payer for 1.5 million reproductive-aged women with disabilities, yet it is the only major form of US health insurance that is not required to cover contraceptives for pregnancy prevention.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether Medicare\u2019s contraceptive coverage gaps were associated with reduced use of contraceptives by enrollees with disabilities.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this national, cross-sectional study, traditional Medicare (TM), Medicare Advantage (MA), and Medicaid claims from female enrollees aged 20 to 49 years receiving Social Security Disability Insurance or Supplemental Security Income from January 1, 2016, to December 31, 2020, were linked. The propensity score\u2013weighted probability of contraceptive use by public insurance type was estimated, then the association between gaining contraceptive coverage through a transition from Medicare to dual Medicare-Medicaid enrollment and contraceptive use was evaluated using a staggered-entry difference-in-differences design. Data were analyzed from December 3, 2024, to April 5, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Public insurance enrollment in TM, MA, dual TM-Medicaid, dual MA-Medicaid, or Medicaid.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Monthly use of permanent contraceptives, long-acting reversible contraceptives (intrauterine device and implant), and short-acting contraceptives (injectable and oral contraceptives, patch, and ring).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 51\u202f501\u202f303 monthly observations from 1\u202f606\u202f129 women were included in the analysis. Mean (SD) age was 35.93 (8.58) years; 1.8% of monthly observations were from Asian women, 30.7% from Black women, 13.0% from Hispanic women, 52.6% from White women, and 1.9% from multiracial women or women identifying as another race and ethnicity not reported on previously. Those enrolled in TM and MA were more often older and non-Hispanic White compared with those dual enrolled or enrolled in Medicaid. The estimated monthly probability of use of any contraceptive method was lowest among TM (4.9%; 95% CI, 4.9%-4.9%) and MA (6.6%; 95% CI, 6.5%-6.6%) enrollees, followed by Medicaid (11.0%; 95% CI, 11.0%-11.0%), dual MA-Medicaid (11.3%; 95% CI, 11.3%-11.4%), and dual TM-Medicaid (13.1%; 95% CI, 13.0%-13.1%) enrollees. Gaining contraceptive coverage through dual enrollment was associated with an increase of 3.9 (95% CI, 3.5-4.3) percentage points (35%) in use of any contraceptive method, with the largest increase in use of short-acting methods at 2.6 (95% CI, 2.3-3.0) percentage points (45%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of contraceptive use in the Medicare program, gaining contraceptive coverage through dual Medicare-Medicaid enrollment was associated with increased contraceptive use among disabled Medicare enrollees, suggesting that Medicare\u2019s coverage gaps pose a financial barrier to desired contraceptive use. Given these findings, Medicare should be required to cover all US Food and Drug Administration\u2013approved contraceptive methods without cost-sharing. Doing so would align Medicare\u2019s coverage requirements with those of Medicaid, private insurance plans, and TRICARE.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.17718","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T11:31:24Z","timestamp":1750851084000},"page":"e2517718","source":"Crossref","is-referenced-by-count":3,"title":["Coverage Gaps and Contraceptive Use Among Medicare Enrollees With Disabilities"],"prefix":"10.1001","volume":"8","author":[{"given":"Meghan","family":"Bellerose","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Ellison","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria W.","family":"Steenland","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Brown University Population Studies and Training Center, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Meyers","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Mitra","sequence":"additional","affiliation":[{"name":"Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa I.","family":"Shireman","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"issue":"3","key":"zoi250559r1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.dhjo.2017.03.014","article-title":"Disparities in receipt of family planning services by disability status: new estimates from the National Survey of Family Growth.","volume":"10","author":"Mosher","year":"2017","journal-title":"Disabil Health J"},{"issue":"2","key":"zoi250559r2","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.dhjo.2018.11.006","article-title":"Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: a systematic 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