Trends in Rehabilitation Insurance Benefit Exhaustion Among Older Adults in the United States and Associations With Racial Identity.

Insurance exhaustion was self-reported and not checked against claims, so it may include people who were told by providers or administrators that coverage had ended, even if rules might have allowed more therapy. The study could not distinguish Medicare fee-for-service from Medicare Advantage plans, which may have different prior authorization and utilization controls. The survey did not specify rehabilitation settings, so the results cannot show how exhaustion differs across inpatient, skilled nursing, outpatient, or home health care. Other race and ethnicity groups were not analyzed because subgroup sizes were extremely small. The repeated cross-sectional design cannot show that policy changes caused the trend, and the adjusted models could not account for unmeasured factors such as implicit bias or local coverage interpretation.

The authors declared no conflicts of interest.

Do not read the drop from 32.0% in 2015 to 27.9% in 2022 as evidence that insurance barriers have been solved. The measure was self-reported, not checked against claims, and the rate rose after 2019.