Even with Medicare coverage, older Americans with serious health conditions are often burdened by medical bills, a new study finds.
In a survey, researchers found that more than half of seriously ill Medicare beneficiaries said they'd had major trouble paying medical bills. Prescription drugs were the biggest hardship, followed by hospital and ambulance bills.
For some, medical bills had far-reaching consequences: More than one-third said they'd used up their savings, while almost one-quarter had been unable to pay for basics like food and heat.
Researchers said that while Medicare is a broadly popular program, the new findings highlight its gaps for the most vulnerable older Americans.
"Studies find that, on average, Medicare beneficiaries are satisfied with the program," said Michael Anne Kyle, a doctoral student at Harvard University who worked on the study. "But there's a group of people where the cost and financial strain is concentrated."
The findings were published Nov. 4 in Health Affairs. They come from a survey of 742 Medicare beneficiaries who were seriously ill. The researchers defined that as having a medical condition that, over the past three years, had required at least two hospital stays and care from three or more doctors.
Overall, 53% said they'd had a "serious problem" paying medical bills. Most said they'd received some financial help from family members or friends, and one-quarter described their medical costs as a "major burden" to their family.
Often, Kyle noted, when the topic of financial strain on families comes up, it centers on long-term care, such as nursing homes, which is not covered by Medicare.
But this study shows that for some older Americans, the issues begin with prescriptions and medical bills. And it is often the whole family that bears the strain — financial and otherwise, Kyle said.
"I think we haven't fully grappled with the amount of work that goes into informal care," she said.
According to Judy Feder, a fellow with the Urban Institute's Health Policy Center, in Washington, D.C., "Medicare is a hugely valuable program. That said, it has holes."
That includes the famous "donut hole," said Feder, who was not involved in the study.
The term refers to the coverage gap in most Medicare prescription drug plans, where beneficiaries temporarily have to pay a larger percentage of their drug costs, after passing a coverage limit.
That hole could be one reason why prescriptions were the biggest financial burden reported in the survey, Feder suggested.
Overall, 30% of survey respondents said they'd had a serious problem paying for medications. Meanwhile, 20% to 25% reported problems with paying hospital, ambulance or emergency department bills.
Feder pointed to another well-known issue in the traditional Medicare program: There is no cap on what beneficiaries pay out-of-pocket.
If such gaps were addressed, that might help relieve financially strapped families, Feder said.
The study did not separate respondents according to whether they had traditional Medicare or were enrolled in a Medicare Advantage plan, Kyle said. So it's not clear whether that makes a difference in the financial burden to seriously ill beneficiaries.
The researchers also found that many respondents were unprepared for the financial toll they'd face. Less than half said they felt "adequately informed" about what their insurance would cover.
"Are people being told about out-of-pocket costs?" Kyle said. "I think we can be doing much more to make sure patients are informed."