Critter Corner: Why Do Many on Medicare Still Struggle to Afford Needed Care?

Dear Oakley,

My 70-year old mother, Lucy, is on Medicare, but she still seems to struggle to afford the medical care she needs, and often puts off making appointments. I thought Medicare was supposed to help make healthcare affordable. Why is this happening?

Metta Kerr

—

Dear Metta,

Medicare was designed to help cover the costs of health care and safeguard the financial security of people ages 65 and older. However, Medicare doesn’t cover everything. It has high cost sharing and does not cover dental, hearing, and vision, and of course does not cover long-term care. Medigap policies (also called Medicare supplement plans) help cover medical costs that Medicare doesn’t pay for, but only cover the same benefits that Original Medicare covers. So, because Original Medicare does not cover dental, vision, or hearing benefits, neither do Medicare supplement plans. However, although Original Medicare doesn’t cover dental or vision, some Medicare Advantage plans could help with the cost of dental and vision care.

Although Medicare provides older adults with significant financial protection from health care costs, many still struggle to afford needed care. In fact, one of five Medicare beneficiaries spent more than $2,000 a year out of pocket for health care, while one of 12 skipped or postponed care they needed because of costs. If people do not receive timely care, health conditions can worsen and diagnoses can be delayed, which can lead to poorer health outcomes and higher overall health care spending.

The Commonwealth Fund examined data collected in the US from their recently released 2021 International Health Policy Survey of Older Adults. To conduct the research, they analyzed a sample population of 1,487 adults ages 65 and older who live in the community (excluding those in long-term care facilities) who reported having Medicare coverage (i.e., original Medicare or Medicare Advantage) and 208 adults between the ages of 60 and 64 with some source of insurance coverage. These are some of the results:

A sizeable share of Medicare beneficiaries, as well as adults nearing Medicare eligibility age, skipped needed medical services, treatments, prescriptions, or dental visits because of cost. Across services, a slightly larger share of adults 60 to 64 skipped needed care because of cost than did Medicare beneficiaries 65 and older, but these differences were not statistically significant.
More than one of five insured adults 60 to 64 and about one of seven Medicare beneficiaries skipped dental care because of cost, even though about half of Medicare beneficiaries and two-thirds of adults ages 50 to 64 have some form of dental coverage.
Recent policy discussions have focused on adding dental coverage to Medicare, but adults nearing Medicare age are also affected by a lack of dental coverage in the ACA marketplaces and in other coverage sources.

According to the research, Medicare beneficiaries are more protected than their slightly younger counterparts from high out-of-pocket medical costs, but they still face challenges. Improving the affordability of care could be accomplished by expanding coverage to the uninsured, increasing coverage subsidies, and improving benefits to close coverage gaps.

To change your current Medicare Supplement plan or Medicare Advantage plan, you can now enroll in Medicare health and drug plans from October 15 – December 7. Get tips for Medicare’s Open Enrollment here.

Hope this helps,

Oakley