A new Commonwealth Fund survey explores the intersection of finances and healthcare among older adults, including differences between Medicare and Medicare Advantage beneficiaries.
High cost-sharing is making it hard for many older U.S. adults to afford needed healthcare. This is compared to other countries and despite having Medicare or Medicare Advantage (MA) coverage. The result is skipped and delayed care — from recommended tests to treatment to follow-up.
These findings from the 2024 Commonwealth Fund International Health Policy Survey of Older Adults highlight the continued gaps between the healthcare systems in America and other high-income countries around the world.
U.S. cost share is not only higher but rising and with broad implications.
“Rising costs are forcing many older Americans to pay more out of pocket, leading to delayed care, poorer health, and higher long-term spending.” So notes Commonwealth Fund Vice President of Medicare, Gretchen Jacobson.
Her colleague — Munira Z. Gunja, Senior Researcher for International Health Policy and Practice Innovations — notes: “In some countries, almost no older adults are skipping or delaying care because of the cost.”
The research goes on to spotlight key findings and possible solutions.
Key findings: High OOP leads to skipped, delayed care
The Commonwealth Fund survey compared older adults in the U.S. with those in nine other high-income nations — Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom — with the following results:
- High out-of-pocket costs: Over the past year, nearly 25% of U.S. adults spent at least $2,000 in out-of-pocket healthcare costs.
- America leads in skipped/delayed care: The U.S. had the highest rates among surveyed countries.
- Dental, drugs reflect the largest disparities: Some 20% skipped need dental care in the U.S., Australia, and Canada, while 2x in the U.S. alone skipped doses of prescription drug or never filled them.
These findings are particularly concerning given that one-third of older U.S. adults with cost-related access challenges reported fair or poor health. These challenges included one of the following during the prior 12 months:
- not visiting a doctor despite a medical issue
- skipping a recommended medical test, treatment, or follow-up
- not filling a prescription or skipping medication doses
Spotlight: Mental health
Mental health care was a bright spot in the survey results. The Commonwealth Fund notes that
“few beneficiaries across countries report skipping this type of care because of costs” — less than 5% of residents across all countries.
Access in the U.S., however, remains challenging due to the difficulty of finding mental health providers who accept Medicare or MA plans. Again, The Commonwealth Fund notes: “Policymakers and researchers should monitor how these access barriers may lead to beneficiaries paying out-of-pocket for mental health care.”
Solutions, at home and abroad
When older Americans can’t afford needed healthcare, it impacts the entire delivery system. Sick patients get sicker and federal Medicare spending increases long term.
The Commonwealth Fund’s Gunja recommends that the U.S. look abroad for solutions, “such as capping out-of-pocket expenses and fully covering hospital and physician services.”
Conversely, home-grown solutions have focused on prescription drug costs. The Inflation Reduction Act includes multiple initiatives in various stages of implementation, including:
- limiting Part D expenses
- expanding low-income subsidies
- capping insulin copayments
- negotiating drug prices with manufacturers
These actions impact Medicare and MA beneficiaries in particular. While The Commonwealth Fund survey found no significant affordability differences between the two, the organization notes that MA plans limit enrollees’ maximum out-of-pocket medical expenses, offer lower cost-sharing opportunities, and typically include at least some dental coverage.
Still, and compared to other countries, Medicare and MA can do better.
“Even though nearly all older adults in the United States are covered by Medicare, this study highlights areas where the program has room to improve,” adds Gunja.
“Medicare was created to ensure older Americans can get the care they need and afford to stay healthy, and it’s critical that we uphold that promise to them.”
Laura Beerman is a freelance writer for HealthLeaders.
KEY TAKEAWAYS
Due to cost, older Americans are more likely to delay or skip needed care, including dental and prescription drugs
This is compared to similar residents in other high-income countries. This is despite having Medicare or Medicare Advantage coverage.
These new findings from The Commonwealth Fund highlight the continued realities of coverage without care in the United States.