Medicare’s Coverage Gaps and Uncapped Cost-Sharing Create Burdens for Sick and Poor
<p>A detailed look at health care costs for Medicare beneficiaries finds that more than one-fourth of beneficiaries—an estimated 15 million elderly and disabled people—spent 20 percent or more of their household income on out-of-pocket medical expenses and monthly premiums in 2016.</p><p>Beneficiaries with high needs—those with multiple chronic conditions or physical or mental disabilities—are at the greatest risk of incurring high costs, the Commonwealth Fund study shows. Nearly one-third of those with three or more conditions spent 20 percent or more of their annual income on premiums and medical care.</p>
<p>Medicare does not limit beneficiaries’ annual out-of-pocket spending and has relatively high cost-sharing requirements. And, with nearly half of beneficiaries earning less than $24,000 a year, many cannot afford supplemental coverage.</p>
<p>“If Medicare reforms are discussed by the new Congress, we have to keep in mind the impact any changes would have on beneficiaries, especially those who are the sickest or have low incomes,” said lead author Cathy Schoen, Senior Scholar in Residence at the New York Academy of Medicine. Karen Davis and Amber Willink, both with the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health, were coauthors of the report.</p>