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53% of Medicare Beneficiaries Have 'Serious Problem' Paying Medical Bills

Analysis  |  By Jack O'Brien  
   November 04, 2019

Paying for prescription drugs represented the most serious financial problem for Medicare beneficiaries in 2018.

More than half of Medicare beneficiaries who dealt with a serious illness reported having a "serious problem" paying a medical bill, according to a study published in Health Affairs Monday afternoon. 

Paying for prescription drugs represented the most significant financial problem for Medicare beneficiaries in 2018, listed as the greatest financial hardship by 30% of respondents. This was followed by hospital bills at 25%, as well as ambulance bills and emergency department visits at 20% each. 

Many Medicare beneficiaries have suffered significant financial consequences as a result of their illnesses, such as using most or all of their savings, receiving calls from debt collection agencies, or lacking the means to pay for basic necessities. 

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The study found that the majority of survey respondents are living at home but rely on friends and family to assist them, oftentimes at a great financial cost. 

Michael Anne Kyle, a doctoral student at Harvard Business School and lead author of the study, tells HealthLeaders that while Medicare is popularly regarded as an insurance option, seriously ill patients have found that the coverage has significant holes. 

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Kyle says Medicare beneficiaries were asked to describe their own hardships for the survey, which explains why prescription drug costs were viewed as a greater financial burden than hospital bills.

"With a prescription drug, that's a recurring cost whereas a hospitalization might be less common, but it might be a bigger bill," Kyle says. "If [a patient] is hospitalized, they might not have been working or working less, so it could be that the entire financial picture has shifted a bit when they get a hospital bill."

Related: 4 Ways to Stop Losing Patients Over Medical Bills

Kyle says that in addition to the cost issues facing patients, many respondents indicated that they don't have the information they need to understand medical bills. Less than half of respondents said they were adequately informed about what costs their insurance covers and less than a third said that their doctor discussed the cost of care with them.

Kyle says these findings present an opportunity for provider organizations to help patients navigate the cost of care upfront and explain what type of bill to expect and how to interpret the bill.

"[Hospitals] could make an effort to be more transparent about costs and [hospitals] could make an effort to look at the information given to patients," Kyle said. "These are sort of twofold, one is a change in policy and practice, while the other is to look at what [a hospital] is giving people and checking whether it's easily accessible."

The reliance of Medicare beneficiaries on informal caregivers serves as another concern arising from the study, Kyle says, since this creates a greater financial strain on friends and family who care for seriously ill patients.

Fifty-five percent of respondents said their medical care has been a burden on their family, with 30% stating that there was a time they didn't receive outside help due to the cost.

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While hospitals and health systems may aim to shorten the length of stay, Kyle says that for a patient no longer receiving care at the institution, the responsibility for additional shifts to untrained friends and family members. 

This presents yet another area for health systems to focus on in order to address the social determinants of health for a vulnerable patient population. 

"For these patients who are seriously ill, who we define as having multiple hospitalizations, it's likely that they will return to [a hospital] in some capacity," Kyle says. "Their condition when they leave may be relevant to the condition [a hospital] gets when they come back."

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.

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