For more than 50 years, Medicare has helped older adults and disabled people of all ages obtain the health care they need while protecting them from the financial burden of excessive medical bills. The Commonwealth Fund’s Advancing Medicare initiative identifies ways in which this crucial program can serve its beneficiaries more effectively and efficiently while promoting improvement throughout the health care system.
Medicare has enormous capacity to leverage change in U.S. health care. More than 50 million older adults and disabled Americans access care through the program, many in private health plans that contract with Medicare to offer covered benefits. In all, the program accounts for a large and growing share of the federal budget. Through the new Center for Medicare and Medicaid Innovation, Medicare has a key role in developing, implementing, evaluating, and spreading innovative models that can change the way health care is organized, delivered, and paid for. These models shape Medicare, as well as other federal and state health insurance programs and private payers, too.
Medicare faces some serious challenges, however. Chief among them are rising costs: both for the federal budget and for the people who are covered by the program. The average beneficiary spends 15 percent of his or her income on health care, compared with just 5 percent for adults under age 65. And because Medicare covers only a portion of medical expenses, most beneficiaries purchase supplementary insurance, adding to their costs.
In addition to budgetary pressures, Medicare faces other challenges: providing more-comprehensive benefits, including dental care; protecting beneficiaries with low or modest incomes from high out-of-pocket costs; and addressing the confusing patchwork of Medicare benefits. Strategies are also needed to serve the expanding number of enrollees with complex care needs and multiple chronic conditions.
The Commonwealth Fund is examining trends in Medicare and studying potential solutions to emerging issues. Fund-supported research is examining how Medicare can:
- Improve access to the benefits and care.
- Assess and disseminate innovations for improving value in Medicare and across the entire health system.
- Examine the Medicare Advantage program of private health plans to determine how it can better meet beneficiaries’ needs, lower costs, and improve health outcomes.
- Improve coordination between Medicare and other public programs, like Medicaid.
Lovisa Gustafsson, Assistant Vice President, Controlling Health Costs