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.
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