Nov 4, 2019 4:52 PM EST
WASHINGTON (AP) — More
than half of seriously ill Medicare enrollees face financial hardships with
medical bills, with prescription drug costs the leading problem, according to a
study published Monday.
The study in the
journal Health Affairs comes as legislation to curb drug costs for seniors
languishes in Congress and the growing financial exposure of patients with
insurance is getting more attention in the nation’s health care debates.
The survey findings
were a surprise to researchers, since Medicare is considered relatively good
coverage and most people have supplemental insurance to fill its gaps. After
drug costs, the most often cited issues were hospital bills, ambulance rides
and emergency visits.
“We did not expect to see this extent of financial hardship in
the Medicare population.”
“It points to a real
issue that has gone under the radar,” said Tricia Neuman, a Medicare expert
with the nonpartisan Kaiser Family Foundation who was not involved with the
study and reviewed it for The Associated Press.
“Survey after survey
shows that people are satisfied with Medicare, but this analysis shows that
people with Medicare who have serious health problems can face very high
out-of-pocket costs, and that’s an issue that hasn’t gotten much attention.”
All told, 53% of
seriously ill Medicare patients said they had major trouble paying their
medical bills.
More than a third
reported using all or most of their savings to pay medical bills, 27% said they
were contacted by a collection agency and 23% were unable to pay for basics
such as food, heat and housing.
Nearly half (45
percent) reported emotional or psychological distress, and 1 in 4 said their
medical costs had become a major burden on their families.
“We did not expect to
see this extent of financial hardship in the Medicare population,” said Michael
Anne Kyle, lead author of the study and a doctoral candidate at Harvard
University.
She said lawmakers may
need to devote more attention to the needs of Medicare beneficiaries with
catastrophic costs.
“Out-of-pocket costs
are very concentrated,” Kyle said. “The sickest population is also getting the
biggest bills. Especially if you are sick over time, you are slowly draining
your bank account.”
The study defined
seriously ill people as those with a condition that over the past three years
required two or more hospitalizations and visits to three or more doctors.
Included in the study
were Medicare recipients 65 and older as well as younger beneficiaries who
qualified for coverage because of disability. Over half had seen five to nine
doctors in the past three years.
Among the most
prevalent conditions were heart disease, cancer and diabetes. Thirty percent
reported that the cost of prescription drugs was their major hardship.
Legislation to curb
the costs of medicines for seniors has advanced this year in Congress, but it’s
unclear if it can pass because the House and Senate remain far apart.
House Democrats want
Medicare to directly negotiate prices for the costliest drugs — a nonstarter
for Senate Republicans. However, there is widespread agreement on putting an
annual out-of-pocket limit on drug costs for Medicare enrollees.
Although President
Donald Trump wants a bill, the House impeachment inquiry has overshadowed
efforts to move legislation. As a candidate, Trump had backed Medicare drug
price negotiations. It’s uncertain if the White House will try to find a
compromise now between the House and Senate positions.
A second study out
Monday also called attention to seniors’ out-of-pocket costs. Focusing on
people with traditional Medicare, the Kaiser Family Foundation estimated that
the average enrollee spent $5,460 out of their own pocket for health care in
2016, counting premiums and medical services. That figure also included
long-term care costs.
The average was lower
— $4,519 — for people living in their communities and not in institutions.
The Health Affairs
study was based on a 2018 national survey of people of any age who suffered
from a serious illness. Researchers decided to go back and take a closer at the
Medicare group because of the unexpectedly high degree of problems.
The margin of error
was plus or minus 4.6 percentage points.
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