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Our Scorecard ranks every state’s health care system based on how well it provides high-quality, accessible, and equitable health care. Read the report to see health care rankings by state.

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Achieving Universal Coverage

Can Medicare Beneficiaries Afford Their Health Care?

Findings from the Commonwealth Fund 2023 Health Care Affordability Survey
Photo, two women huddle over computer in room

Kathy Elles-Kelemen goes over bills and medications with her 97-year-old mother, Doris Elles, at a senior citizens’ community in Dallas, Ore., on February 8, 2023. In a recent survey, a third of Medicare beneficiaries said it was difficult to afford health care costs. Photo: Melina Mara/Washington Post via Getty Images

Kathy Elles-Kelemen goes over bills and medications with her 97-year-old mother, Doris Elles, at a senior citizens’ community in Dallas, Ore., on February 8, 2023. In a recent survey, a third of Medicare beneficiaries said it was difficult to afford health care costs. Photo: Melina Mara/Washington Post via Getty Images

Authors
Gretchen Jacobson, Faith Leonard, Sara R. Collins
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Even Americans who have health insurance can struggle to pay for expenses like premiums, copayments, coinsurance, and uncovered health services. This includes many people with Medicare, both over and under age 65, many of whom cope with complex health care needs and live on fixed incomes. Faced with high out-of-pocket health costs and living expenses, a substantial number of Medicare beneficiaries are forced to choose between receiving needed care and paying for other essentials like food and utilities.

The downloadable chartpack presents findings from the Commonwealth Fund 2023 Health Care Affordability Survey, a new, nationally representative survey of 7,873 adults age 19 and older fielded from April 18 through July 31, 2023. Focusing on the experiences of the 1,978 Medicare beneficiaries included in the sample, the exhibits show that:

  • One-third of Medicare beneficiaries said it was difficult to afford health care costs, including more than half of beneficiaries under age 65.
  • More than one in five beneficiaries reported delaying or skipping needed health care because of the cost, including more than four in 10 under age 65.
  • More than one in five beneficiaries said health care costs made it harder for them to afford food and utility bills, including more than four in 10 under age 65.

For more findings from the Commonwealth Fund 2023 Health Care Affordability Survey, see Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer.

HOW WE CONDUCTED THIS SURVEY

The Commonwealth Fund 2023 Health Care Affordability Survey was conducted by SSRS from April 18 through July 31, 2023. The survey consisted of telephone and online interviews in English and Spanish and was conducted among a random, nationally representative sample of 7,873 adults age 19 and older living in the continental United States. A combination of address-based (ABS), SSRS Opinion Panel, and prepaid cell phone samples were used to reach people. In all, 4,417 interviews were conducted online or on the phone via ABS, 2,718 were conducted online via the SSRS Opinion Panel, and 738 were conducted on prepaid cell phones.

The sample was designed to generalize to the U.S. adult population and to allow separate analyses of responses from low-income households. Statistical results were weighted in stages to compensate for sample designs and patterns of nonresponse that might bias results. The first stage involved computing a base weight separately within each of the three sample sources to account for differential selection probabilities and response rates across sample strata, overlapping sample frames, and the sampling of one adult per household in the ABS. In the second stage, the demographic profile of the sample is calibrated to target population parameters. The data are weighted to the U.S. adult population by sex, age, education, geographic region, family size, race/ethnicity, population density, civic engagement, and frequency of internet use, using the 2022 U.S. Census Bureau’s Current Population Survey (CPS).

The survey has an overall maximum margin of sampling error of +/– 1.5 percentage points at the 95 percent confidence level. As estimates get further from 50 percent, the margin of sampling error decreases. The ABS portion of the survey achieved a 15 percent response rate, the SSRS Opinion Panel portion achieved a 2.8 percent response rate, and the prepaid cell portion achieved a 2.9 percent response rate.

This brief focuses on 1,978 adults age 19 and older with Medicare coverage who were insured all year. The survey has a maximum margin of sampling error of +/– 1.7 percentage points at the 95 percent confidence level for this age group.

ACKNOWLEDGMENTS

The authors thank Robyn Rapoport, Elizabeth Sciupac, Hope Wilson, Rob Manley, and Jonathan Best of SSRS; and the Commonwealth Fund’s Joseph Betancourt, Melinda Abrams, Chris Hollander, Barry Scholl, Bethanne Fox, Neil Powe, Paul Frame, Jen Wilson, Arnav Shah, Relebohile Masitha, Munira Gunja, Evan Gumas, and Akeiisa Coleman.

Publication Details

Date

Contact

Gretchen Jacobson, Vice President, Medicare, The Commonwealth Fund

[email protected]

Citation

Gretchen Jacobson, Faith Leonard, and Sara R. Collins, Can Medicare Beneficiaries Afford Their Health Care? Findings from the Commonwealth Fund 2023 Health Care Affordability Survey (Commonwealth Fund, Oct. 2023). https://doi.org/10.26099/bgah-g297

Area of Focus

Topics

Medicare,
Affordability,
Medical Bills and Debt,
Costs and Spending

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