Medical Care Costs: Government Insurance Doesn’t Mean Worry-Free


Medical Care Costs: Government Insurance Doesn’t Mean Worry-Free Interview with:

Dr Madden

Jeanne Madden, PhD
Associate Professor
Department of Pharmacy and Health Systems Sciences
School of Pharmacy and Pharmaceutical Sciences
Bouvé College of Health Sciences
Northeastern University What is the background of this study?

Answer: Medicare is the US public insurance program that primarily serves people age 65 and older, but also some younger adults with long-term disabling illnesses. As such, on average, the Medicare population carries a heavy disease burden and has high health care needs, compared to the general population of the United States. The under-65 age group mostly have fairly low incomes, while the older age group represents a wide spectrum, from poor to well-off. Medicare beneficiaries also differ widely in their access to supplemental insurance that can help meet patient cost-sharing requirements. I’m referring to Medicaid assistance, or a self-purchased Medigap plan, or retiree health benefits, etc. direct expenses. This contrasts with commercial insurance and Medicare Advantage managed care plans – all of these have an annual cap on out-of-pocket patient charges.

There is a fair amount of existing research on whether people with Medicare can afford their medications and on the affordability of medical care among younger groups such as uninsured people of working age and those in ACA exchange plans. But there hasn’t been much research on the affordability of medical care among older Americans. What are the main results?

Answer: Well, we looked at two main “types” of affordability reported by enrollees who participated in Medicare’s annual Big Science Survey. Participants were asked if they had delayed care because of cost, and also if they had had any problems paying their medical bills – including maybe they just couldn’t pay at all, had medical debts or had been contacted by collection agencies. About 11% delayed care overall, and 11% struggled to pay bills, and together 16% did one or the other or both.

But it’s when you look closely at particular vulnerable pockets within the population that you really see the problems. Among the under-65 age group, about 2 in 5 reported some type of unaffordability. We also found particularly high rates among older people with multiple chronic conditions or showing symptoms of depression or anxiety. In addition, poverty, not surprisingly, was strongly associated with difficulty paying for care. We also noted that seniors who were “near poor” reported a lot of hardship – because not only are they low-income, but they don’t qualify for financial assistance programs like Medicaid. What role does the cost of drugs play, especially specialty drugs for psoriasis, Alzheimer’s, cancer, etc.? ?

Answer: Our study involved a survey section focusing on medical care – this section did not ask specific questions about medications. There are separate issues around drug affordability, and we’ve researched that quite extensively in the past. The Medicare survey recently added new questions about medical care affordability that hadn’t been asked before. Nevertheless, I imagine high medical costs often still play a part here – because that’s the problem, so many of these people are juggling a range of costly needs on very limited resources, and have to make decisions and compromises – “Am I skipping this prescription or this visit, or maybe I have to do both, but I can’t afford to buy food or pay my rent?” It shows in the strong association between unaffordable care and symptoms of stress Many are vulnerable along several aggregated dimensions What should readers take away from your report?

Answer: Many people might assume that having this government health insurance means not having to worry about medical care costs, but that’s not true. Medicare helps a lot with access to care, but not everyone has full access to what they need yet. It is not a fair situation on the ground. If cost sharing is out of reach for someone of very modest means, they may not be treated. And for those who need treatment for multiple chronic conditions, all of those individual cost-sharing amounts really add up, which causes them more problems in that they can’t afford what they need.

It might be helpful for health care providers to be aware of the extent of the problem. Patients or providers could try to have an honest conversation about these kinds of cost barriers, and hopefully that might lead to a more affordable care planning strategy, or maybe getting help for which some people may not have realized they were already qualified. What recommendations do you have for future research as a result of this work?

Answer: It would be good to get more data and more precision on the specific types of care that are the most difficult to pay for. We know which enrollee groups are most at risk, but the role of supplemental insurance, and whether people have an adequate opportunity to obtain it, and whether choosing Medicare Advantage leads to better cost protection exorbitant – all this needs to be examined more closely. . And of course, policy proposals have long been on the table to ease the burden of high cost-sharing for one purpose – like expanding Medicare financial assistance programs so that people in the “near poor” can also get help, or place a cap on patient spending on traditional health insurance. If this happens, we would like to examine to what extent it helps and especially if it improves health outcomes for people currently at high risk of affordability.

No conflicts to disclose.


Madden JM, Bayapureddy S, Briesacher BA, et al. Affordability of medical care among Medicare enrollees. JAMA Health Forum. 2021;2(12):e214104. doi:10.1001/jamahealthforum.2021.4104

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