JustCare

Tag: Affordability

  • Nearly half of Americans can’t afford their health care

    Nearly half of Americans can’t afford their health care

    Time passes and health care costs rise, as do the number of Americans who can’t afford their health care, according to a new Gallup and West Health poll, reports Aimee Picchi for CBS News. Not surprisingly, people of color are struggling most to pay for their care, as are people in their 50’s and early 60’s, who are not yet eligible for Medicare. But, eight percent fewer people over 65 are able to afford their care now than just two years ago.

    Only about 55 percent of Americans between the ages of 50 and 64 are “cost secure.” They can afford care and prescription drugs. But, that percentage is dwindling quickly. Two years ago, 61 percent reported being “cost secure.

    Even with Medicare, just 71 percent of people are cost secure, down from 79 percent in 2022. Younger adults are the least cost secure. Fewer than half of them (47 percent) can afford their health care, down five percent from two years ago.

    The new poll found that 45 percent of respondents reported skipping care or not filling their prescriptions because of the cost or an inability to get them.  Eight percent of those people said that if they needed care now, they would not be able to get it at an affordable cost. Gallup termed these people “cost desperate.”

    Around one in three U.S. adults, more than 72 million people, said that they had not got care they needed in the past three months because of the cost. Of those 72 million, more than eight million are 65 or older.

    Black and Hispanic Americans are increasingly cost desperate. About one in seven Hispanic adults and one in nine Black adults are cost desperate. Seven percent of White adults are cost desperate.

    What’s causing this increase in the number of Americans who can’t afford their care? Inflation has driven up health care costs. And, doctors and hospitals can charge pretty much what they please, with little accountability. Moreover, insurers keep increasing their deductibles, the amount people must pay out of pocket before their insurance coverage kicks in.

    In 2022, the typical insurance deductible for a family was $3,800. That deductible reflects more than a 50 percent increase ($1,300) from 2013.

    Overwhelmingly, Americans believe that health care costs too much and they are not getting bang for their buck. But, they are not advocating for Medicare for all or even a government-regulated system that sets prices for health care services, which would bring their costs down.

    People are eating less to pay for their prescription drugs. We don’t know how many are dying prematurely because they can’t afford their heart and other medicines, but it’s a good bet thousands are each year.

    Today, the average annual cost of health care in the US per person is $12,555. In Germany, Italy and France, the average annual cost is around $6,651, almost half of what we spend.

    Insurers are keeping people from getting the health care they need. They deny and delay care inappropriately. They refuse to pay for medically necessary services.

    Here’s more from Just Care:

  • Older adults are extremely worried about affording health care

    Older adults are extremely worried about affording health care

    Older adults are extremely worried about affording their health care, concerned they will not be able to pay for the care they need, reports Judith Graham for KFF Health News. Health care affordability is top of mind for older adults as they see prices rising for all their basic needs.

    The National Poll on Healthy Aging found that people over 50 had three major health care concerns: costs, costs and more costs. The cost of medical care, the cost of long-term care and the cost of prescription drugs. People were “very concerned” about these costs.

    People surveyed had other concerns, also related to costs, including the cost of health insurance and Medicare and the cost of dental care. They were also concerned about financial scams.

    People were less concerned about loneliness, being overweight and age discrimination.

    It’s not surprising that older adults are so concerned about health care costs. Twenty-five percent of older adults depend entirely on Social Security for their income, which averages $1,913 a month for an individual. Ten percent of older adults have annual income below the federal poverty level.

    Older adults cannot rely on Medicare, be they in Traditional Medicare or a Medicare Advantage plan, to cover their dental, vision or hearing care or their long-term care. Medicare only covers limited care in a skilled nursing facility or at home if you meet certain criteria. And though Medicare Advantage plans like to tout the dental, vision or hearing care they cover, they tend to offer very limited benefits that are of little help to covering the costs of the services people need.

    People often go without dental care and eyeglasses since Medicare does not cover them. On average, people with Medicare spend about $7,000 a year on medical care. Younger people spend about $4,900 on average.

    People also struggle to pay for long-term care. Nursing home care costs $104,000 on average in 2023. Care in an assisted living facility costs $64,200 on average in 2023. Services at home from home-health aides cost $75,500 a year on average.

    A large proportion of older adults–17 million–live on less than $30,120 a year ($40, 880 for a couple,) twice the federal poverty level. After you pay for Medicare Part B and D premiums and a Medicare supplemental policy, millions of people with Medicare have spent more than 4o percent of their monthly Social Security check, about $468 out of $1,121.

    Medicare Savings Programs can help cover Medicare premiums and out-of-pocket costs. You can apply through your Medicaid office. You qualify based on your income and assets, but many people are unaware of the programs. Six million people qualify who are not enrolled, according to Graham.

    You can check out additional programs that lower your health care costs here.

    Here’s more from Just Care:

  • People in Medicare Advantage struggle to afford their care

    People in Medicare Advantage struggle to afford their care

    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:

  • Six tips for keeping your drug costs down if you have Medicare

    Six tips for keeping your drug costs down if you have Medicare

    Many people with Medicare find that they are paying a hefty amount for their drugs, even with prescription drug coverage. Drug companies have considerable power to set high prices for many drugs; insurers have little power to rein them in. Instead, insurers shift costs onto members who need high-cost drugs. That helps explain why government drug price negotiation remains a top policy issue in polls of likely voters. For now, there are ways to keep your drug costs down.

    Whether you are enrolled in a Medicare Part D prescription drug plan or a Medicare HMO or other private Medicare plan, copays or coinsurance for some drugs can be extremely high. Here are some options to save you money.

    1. Review the drugs you are taking with your doctor:  Your primary care doctor might be able to shorten the list of drugs you’re taking and, in the process, save you money. If you’re taking high-cost brand-name drugs, your primary care doctor might also be able to prescribe you lower-cost generic drugs. Generics must have the same active ingredients, same strength and purity and same effect.
    2. Ask your Part D drug plan or private Medicare plan about reducing your copay: If your drug is in the highest tier—requiring a very high copay–the plan might reduce the copay if your doctor can demonstrate that you have no other drug alternative for your condition that safely meets your needs.
    3. Extra Help: If you qualify for Extra Help, a program administered by Medicaid, it will pay for some or all of the cost of your drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2023, you may qualify if you have up to $20,385 in yearly income ($27,465 for a married couple) and up to $16,660 in assets  ($33,240 for a married couple). With Extra Help your drug costs are no more than $4.15 for each generic/$10.35 for each brand-name covered drug. You pay nothing after your total drug costs exceed $7,400. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program. You can apply for Extra Help online here.
    4. Find out if you qualify for a State Pharmaceutical Assistance Program: In some states, state pharmaceutical assistance programs provide help with the cost of drugs. Visit Medicare.gov or contact your State Health Insurance Program to find out about drug benefits your state provides. You can also call 1-800-677-1116 or visit www.eldercare.gov.
    5. Drug company assistance programs: Some drug companies offer eligible individuals reduced prices for their drugs. Contact the Partnership for Prescription Assistance or NeedyMeds to find out if you qualify for help with your drug costs.
    6. Online pharmacies: You can often find significantly lower-priced drugs through online pharmacies. And, increasingly, people are using international online pharmacies to keep their costs down. Kaiser Health News reports that 19 million people in the U.S.–eight percent of Americans–now buy their drugs outside the US to afford them. But, you must be careful you are using a legitimate pharmacy and not an outfit selling counterfeit or expired drugs. Also, it is technically illegal to import drugs from abroad, although it appears that no one has been prosecuted for doing so for personal use. Here’s what to consider.

    Keep in mind: If you are a Vet, you likely can get low-cost drugs through the Veterans’ Administration.

    N.B. This post was originally published on November 18, 2019 and has been updated.

    Here’s more from Just Care:

  • Most middle-income older adults will not be able to afford long-term care

    Most middle-income older adults will not be able to afford long-term care

    According to a new study by NORC at the University of Chicago, ten years from now, 11.5 million of the 16 million middle-income older adults might not be able to afford the long-term care they need. And, Medicaid is unlikely to help them. It’s wise to plan ahead in case Congress does not step in.

    How will middle-income older Americans afford their housing and care needs? With annual income under $65,000, they will not have enough money to cover these basic necessities. More than half of them, 6.1 million, could not afford these key needs even if they were to sell their homes. More than one in five of them are people of color.

    Long-term care affordability will be especially critical for the 9.5 million of them who live alone—never married,  widowed or divorced. More than 4.4 million of them do not have children living within daily caregiving distance. Without a spouse or kids to provide voluntary caregiving, middle-income older adults are at serious risk.

    People tend to experience multiple health issues by the age of 75. Slightly more than half of them are projected to have at least three chronic conditions. Slightly more than half of them are also projected to have difficulty moving.

    Health conditions and mobility limitations tend to increase as people age, making the need for log-term care all the greater.

    “We need a combined public and private response to address the long-term care needs of the Forgotten Middle,” says Caroline Pearson, senior Vice President of NORC, lead author of this study. “Policymakers should examine healthcare and housing policies that can extend funding for personal care and caregiving support to avoid middle-income seniors spending down to nursing homes.”

    Here’s more from Just Care:

  • Poll: Prescription drug prices in 2022

    Poll: Prescription drug prices in 2022

    The Kaiser Family Foundation recently polled Americans for their views on prescription drug prices. Here’s what they learned:

    What proportion of the US population takes prescription drugs?

    • Most Americans–62 percent–take at least one prescription drug.
    • One in four Americans take at least four prescription drugs.
    • More than eight in 10 (83 percent) Americans say prescription drug costs are unreasonable.
    • Nearly seven in 10 (69 percent) Americans who take prescription drugs say that they have no trouble affording them.

    Are prescription drugs affordable?

    A recent report in NBER found that thousands of people with Medicare die of stroke, heart attacks and other diagnoses each year because they stop filling their prescriptions when the copays rise as little as $10.40.

    • Affordability of prescription drugs is harder for people who are taking four or more medicines.
    • Nearly one in three people (32 percent) who take four or more medicines struggle to pay for their prescription drugs.
    • Only about 2o percent of people who take up to three prescriptions struggle to pay for them.
    • At least a third of people with yearly incomes under $40,000 (35 percent) and people with chronic conditions (33 percent) also have more difficulty affording their prescription drugs.
    • One in five people over 65 (2o percent) say they struggle to afford their prescription drugs.

    How many people do not fill their prescriptions because of the cost? 

    • Three in ten people did not fill all their prescriptions in the last year, as a result of the cost.
    • One in six (16 percent) did not fill a prescription for a specific drug because of the cost.
    • More than one in five (22 percent) substituted a non-prescription drug for their prescription.
    • More than one in eight (13 percent) cut their pills in half or skipped doses.

    Do people understand that drug company profits are the largest reason for high costs in the US?

    • The overwhelming majority of the public (82 percent) understands that pharmaceutical company profits are the largest reason drug prices are so high.
    • Nearly seven in ten people (68 percent) wrongly believe that research and development costs are responsible for high drug prices.
    • More than half of people (52 percent) mistakenly think that marketing and advertising drive drug prices as high as they are.

    Most Americans would like to see more drug price regulation, including a majority of Democrats, Republicans and Independents.

    What drug price proposals do Americans favor?

    • Nearly nine in ten Americans (88 percent) would like it to be easier for generics to come to market.
    • Nearly nine in ten Americans (88 percent) would like Congress to limit drug price increases to the rate of inflation (which does nothing to keep the launch price of a drug reasonable.)
    • Eighty-five percent would like Medicare to limit out-of-pocket drug costs (which does nothing to lower drug costs, gives drug companies greater freedom to raise prices since people don’t directly feel the increase, and allows insurers to shift drug costs to everyone through higher premiums and other out-of-pocket costs.)
    • More than eight in ten Americans (83 percent) would like the government to regulate drug prices.
    • Nearly eight in ten Americans (78 percent) support legalizing drug imports from Canada (though there is no reason not to open the borders to drugs from verified pharmacies around the world.)

    Here’s more from Just Care:

  • 2022: Health care costs remain a top policy priority

    2022: Health care costs remain a top policy priority

    A new Kaiser Family Foundation poll finds that Americans continue to see their health care costs as a top policy priority for Congress. Health care prices and unexpected medical bills are a major concern. Slightly more than half of Americans polled say they have delayed or gone without health care in the last 12 months because of the cost.

    When it comes to household expenses, one in four Americans are very worried about facing unexpected health care bills. Health care costs are their top household expense worry after gasoline and transportation costs, which 40 percent of Americans are very worried about. Nearly six in ten Americans (58 percent) are very worried or somewhat worried about facing unexpected medical bills.

    What types of health care have people foregone? More than a third of Americans (35 percent) went without dental care in the last 12 months because of the cost. One in four went without eye care (25 percent) or a visit to the doctor (24 percent). About one in six (18 percent) went without mental health care and about one in seven (14 percent) went without hospital care.

    How do Americans want Congress to address these issues? Most of the poll answers focused on people’s out-of-pocket costs and not on health care prices. Americans seem to be more focused on having Congress limit what they pay for their care than on regulating prices. What they might not appreciate is that the money to cover limits on their costs is going to have to come from somewhere. Would they want the money to come from higher taxes, or do they also support price regulation?

    The public wants Congress to prioritize a limit on prescription drug price increases to the rate of inflation (61 percent) over regulation of drug prices (48 percent) for working people. Do Americans understand that a limit on drug price increases does not preclude the introductory price of a drug from being through the roof?

    The public overwhelmingly supports drug price negotiation for people with Medicare; 98 percent of Democrats and 84 percent of Republicans see it as a top priority.

    The public also supports out-of-pocket drug caps and caps on insulin costs as a top priority for lawmakers. But, at what cost to them? Those caps are likely to drive up overall health insurance premiums considerably if they are not combined with drug price regulation.

    The public feels less strongly that policymakers continue to fund COVID-related health care costs. Only about one in four Americans believe Congressional investments in COVID health care should be a top priority.

    Views of the Affordable Care Act are split along party lines. Nearly nine in ten (87 percent) Democrats see the ACA favorably, with more than four in ten of them (43 percent) saying the ACA helped them and their families. In sharp contrast, nearly eight in ten (79 percent) Republicans view the ACA unfavorably, with four in ten saying it hurt them and their families.

    Overall, Americans have a negative view of long-term care facilities’ staffing levels, fees and care quality. The 25 percent of Americans with some direct familiarity with long-term care facilities have even stronger negative views of them.

    Here’s more from Just Care:

  • Access to affordable care improves when people enroll in Medicare

    Access to affordable care improves when people enroll in Medicare

    A new paper in Health Affairs by Paul Jacobs looks at the impact of Medicare on access to affordable care. It finds that enrolling in Medicare–be it traditional Medicare or Medicare Advantage–improves access and affordability of care for people turning 65. It further finds that expanding Medicare to people under 65, as President Biden and others have proposed, is likely to provide better access to affordable care than their private insurance options.

    Today, people with Medicare say that they have about the same or better access to care as people with private insurance. They also do not have problems finding a new doctor. This is particularly noteworthy as people with Medicare use a lot more health care services than people under 65.

    Jacobs reports that about 15 percent of people age 57 do not have a usual source of care as compared with 6.3 percent at age 72, thanks to Medicare. And, 6.3 percent of people age 64 had difficulty getting needed care because of cost as compared to 3.7 percent of people age 66.

    That 2.6 percent increase in ease of getting care for people with Medicare translates to 22.1 percent more people having a usual source of care once on Medicare. And, 50.9 percent more people were able to get needed care once on Medicare. Affordability of care also improved significantly for people enrolling in Medicare. At age 66, 46 percent more people could afford to get care.

    Jacobs did not find any subpopulation with worse access or affordability once enrolled in Medicare. Access and affordability of care improved for everyone. That said, white Americans and Hispanics had greater improvements to access and affordability than non-Hispanic Black Americans. White people and Hispanics also had fewer delays in care because of the cost than non-Hispanic Black Americans.

    Jacobs remarks on Medicare’s great strengths as compared to private insurance. He notes that it would not have been surprising to find access issues with Medicare given that Medicare payment rates tend to be significantly lower than private insurance rates. But, people with Medicare did not have trouble finding doctors nor did they face delays getting care. He further notes that it would not have been surprising to find an increase in affordability issues given that older adults use more health care services and have lower incomes than younger adults.

    Based on the study results, if the goal is to improve access and affordability of care, it would be a mistake to raise the age of Medicare eligibility, as many Republicans propose. Rather, we need to improve and expand Medicare to everyone.

    Here’s more from Just Care:

  • Coronavirus: Americans travel abroad for medical care

    Coronavirus: Americans travel abroad for medical care

    Right now, in the midst of the novel coronavirus, medical tourism is not what it used to be. But, Americans are still desperately in need of treatment that they cannot afford in the US. Many have no choice but to travel abroad for medical care and, since no one’s out and about, it’s easy to get an appointment.

    Ceylan Yeginsu reports for the New York Times on one woman with endometriosis, who lost her job and her health insurance and was forced to put off getting treatment as long as she could withstand the pain because of the cost. She found a hospital in Mexicali, Mexico to perform the hysterectomy she needed at a cost of $4,000. The cost in New Jersey is $20,000.

    More than one in every hundred Americans travel abroad for their health care, in order to save money. They tend to go to Mexico and Costa Rica when they need dental care and prescription drugs. They often go to Thailand, India and South Korea for invasive medical procedures, be it to treat cancer or heart disease or some other serious condition.

    Not as many people are traveling abroad now for medical care or any other reason because of travel restrictions and quarantine requirements. But, unemployment and uninsurance are leading many low and middle-income Americans without a choice. Care in the US is unaffordable.

    And, even though the US-Mexican land border is closed to tourists, Americans can travel to Mexico for dental care and prescription drugs. One Delta Air Lines flight attendant walked across the border at Los Algodones to a dental clinic that replaced his crowns. Instead of paying $25,000 in Florida for the procedure, he paid $7,000.

    In case you’re interested, Turkey is a destination for hair transplants. Nationals must observe curfews to help contain the novel coronavirus. But, foreigners do not have to abide by these restrictions. Some suggest that now is the time to go since there’s plenty of availability.

    Here’s more from Just Care:

  • To save money on your care, consider using a free health clinic

    To save money on your care, consider using a free health clinic

    Because health insurance no longer covers large portions of people’s health care costs, millions of people with insurance are struggling to pay their premiums, deductibles, copays and costs for out-of-network care. Did you know that even if you have insurance, you may be able to save money on your care by using a free local clinic? According to Kaiser Health News, many people rely on free health clinics and these clinics are growing to meet their needs.

    There are 1200 free and charitable health clinics across the United States. Using a free clinic for your care could save you hundreds of dollars a year. If you qualify for care, you could get lower-cost prescriptions through these clinics as well as lower-cost primary medical care. Some clinics also offer mental health care and dental care.

    Many free health clinics serve the underinsured–people with health insurance whose out-of-pocket costs for premiums and deductibles amount to at least 10 percent of their income–as well as the uninsured. So, it’s worth looking into them even if you have insurance.

    The Commonwealth Fund found that in 2014 almost one in four adults under 65 were underinsured, 31 million people; people who are underinsured may have a deductible that is at least five percent of their annual income, or they may spend at least ten percent of their income on out-of-pocket costs, excluding their premiums.

    If you’re struggling to get an appointment with a doctor, using a free health clinic also may enable you to get an appointment more quickly.

    To find a free or charitable health clinic near you, visit the National Association of Free and Charitable Clinics.

    Here’s more from Just Care on free and low-cost care: