Medicare offers very good coverage of inpatient and outpatient medical services, but it comes with significant out-of-pocket costs. A new report from The Commonwealth Fund lays out how these additional costs affect access to care for older adults and people with disabilities. In sum, people in Medicare Advantage are as likely to struggle to afford their care as people in Traditional Medicare.
Unless they qualify for Medicaid or a Medicare Savings Program, people with Medicare generally pay monthly Medicare Part B premiums, deductibles, coinsurance and copays. They also generally pay all or most of the cost of dental, hearing, vision and long-term care services.
Nearly 20 percent of people with Medicare face burdensome out-of-pocket costs–they are underinsured–based on their income. Whether they are in Traditional Medicare or Medicare Advantage, particularly people whose income is under twice the federal poverty level ($27, 180 for an individual and $36,620 for a couple in 2022) but who do not qualify for Medicaid, struggle to pay for their care. About 21 million people with Medicare have incomes under 200 percent of the federal poverty level.
The Commonwealth Fund survey found that 38 percent of people with Medicare reported one or more problems accessing care during the year. As a result, these Americans might have not filled a prescription or gone to the doctor or dentist. People in Traditional Medicare and Medicare Advantage experienced access to care problems at the same rate. People with annual incomes above $55,000 experienced fewer problems accessing care.
Medicare Part B premiums alone are substantial. And, 23 percent of people with Medicare reported that it is a challenge to pay these premiums. Nearly four in ten people with incomes under 200 percent of the federal poverty level reported a challenge paying these premiums.
If you’re in a Medicare Advantage plan, out-of-pocket medical and inpatient costs can be as high as $8,300 a year in 2023 for in-network services alone, depending upon the Medicare Advantage plan you’re enrolled in. If you’re in Traditional Medicare, these costs are very limited if you have Medicare supplemental coverage or Medigap, retiree coverage from a former employer or Medicaid. But, if you do not have this extra coverage, your costs are uncapped.
And, while people often join a Medicare Advantage plan believing they will get help with the cost of dental care, often that help appears better than it is. The data show that 30 percent of people in Medicare Advantage plans do not get dental care because of the cost as compared with 24 percent of people in Traditional Medicare. More people in Medicare Advantage plans have incomes under 200 percent of the federal poverty level than people in Traditional Medicare.
Medical debt is another challenge facing older adults. One in six people with Medicare said they struggled with a medical bill or medical debt. People enrolled in Medicare Advantage plans faced significantly more medical bill problems and medical debt problems than people in Traditional Medicare, particularly people with incomes between 200 and 4oo percent of the federal poverty level.
Twenty-eight percent of people facing medical debt and medical bills reported depleting their savings.
Here’s more from Just Care:
- Older adults in US face high cost-related barriers to care
- The deadly consequences of out-of-pocket drug costs
- New Medicare rule should lower health care costs for 860,000 people
- Medicare patients with liver cancer face $10,000 in out-of-pocket costs
- Six tips for keeping your drug costs down if you have Medicare
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