THURSDAY, July 19 (HealthDay News) — Older Americans enrolled in Medicare health plans have better access to care and are less likely to have problems paying their medical bills than people who insure themselves or receive coverage through their employers, according to a new study.
As the U.S. government considers proposals to cut Medicare spending, researchers from the Commonwealth Fund, a private health-policy advocacy foundation, cautioned that the health and financial security of people on traditional Medicare plans could suffer if policy makers move them to private Medicare Advantage plans. They noted that those enrolled in these private plans are less satisfied with their insurance and have more problems receiving the care they need.
“Policies designed to move the elderly out of Medicare and into private plans need to be carefully designed, so as not to expose beneficiaries to the poorer access to care currently experienced by many working-age adults with private insurance,” said Kristof Stremikis, senior researcher at the Commonwealth Fund, in an organization news release.
The study was based on a 2010 health insurance survey conducted by the Commonwealth Fund that involved more than 4,000 U.S. adults.
Although only 8 percent of people with Medicare rated their insurance as fair or poor, 20 percent of adults covered by an employer-sponsored plan and 33 percent of those who purchase their own insurance reported dissatisfaction with their coverage.
In 2010, the study found, 23 percent of Medicare beneficiaries were unable to afford the care they needed. The same was true for 37 percent of those who received insurance through their jobs.
Meanwhile, those with employer-sponsored health plans and those who bought their own insurance were nearly twice as likely to report problems with their medical bills than people with Medicare, the study found.
The researchers said coverage of Medicare beneficiaries improved over the past decade, while access to care and problems with medical costs got worse for adults with other types of health plans.
People with individual or employer-sponsored health plans were much more likely to have high out-of-pocket expenses, the researchers said. Although 29 percent of older adults on Medicare reported spending 10 percent or more of their income on medical costs, 37 percent of those with employer-based insurance and 58 percent with individual insurance did the same.
Paying rent and buying food and other essentials was a problem for 27 percent of adults with employer-sponsored plans and 33 percent of those with individual insurance. On the other hand, 13 percent of Medicare beneficiaries were unable to pay for their basic necessities.
For Medicare patients, however, satisfaction with their coverage depends on whether they were enrolled in traditional Medicare plans or in Medicare Advantage plans that are offered by private insurance companies.
Although 15 percent of people with Medicare Advantage rated their insurance as fair or poor, just 6 percent with traditional Medicare felt the same way about their coverage.
People with Medicare Advantage plans also were more likely to have trouble affording their medical care than those with traditional Medicare. Thirty-two percent of those enrolled in Medicare Advantage had at least one problem with accessing care due to cost, compared with 23 percent of those with traditional Medicare.
“In the policy debates over the federal budget deficit, the affordability of Medicare and the expansion of health insurance through the Affordable Care Act, listening to the experiences of individuals — whether covered by Medicare or private employer insurance — is important,” the study’s authors wrote.
The researchers concluded that state insurance exchanges to be established in 2014 may be a way for states to offer traditional Medicare coverage to working-age adults.
“As we expand insurance and move toward near-universal coverage, it is imperative that we ensure health plans provide financial protection and good access to care,” Karen Davis, president of the Commonwealth Fund, said in the release. “The achievements of Medicare in fulfilling the goals of health insurance coverage for beneficiaries can provide important lessons for the entire U.S. health system.”
The study was published July 18 in the journal Health Affairs.
More information
Visit the U.S. Centers for Medicare and Medicaid Services to learn about Medicare.