FFS Medicare can boast of lower cost hurdles than private health insurance


By Kelsey Waddill

– Adults aged 65 and over with traditional health insurance boasted of having similar access to care and a lower rate of barriers to care than privately insured seniors aged 50 to 50. 64 years old, a Kaiser Family Foundation (KFF) report revealed.

“The high and rapidly growing health care spending in the United States is of concern to consumers, employers, taxpayers and policymakers,” the researchers began. “The relatively high prices paid by private insurers are one of the main factors fueling this trend, leading some policymakers to question whether Medicare tariffs, or a multiple of Medicare tariffs, should be used to help control costs. costs and solve accessibility issues for individuals Private insurance. “

The study used the 2018 Survey of Current Medicare Beneficiaries and the 2019 National Health Interview Survey to assess differences in the quality and costs of care for traditional Medicare beneficiaries and elderly people insured by the Medicare. private sector.

About 16 percent of privately insured seniors said they encountered cost barriers. Cost concerns have caused these elderly people to delay or avoid medical care.

In contrast, 11% of traditional Medicare beneficiaries said they had encountered cost issues that led to delay or avoidance of care.

While the gap was present between these two populations overall, it was particularly evident in the segment of each population that was in poor health. About 33 percent of privately insured seniors who were in fair or poor health – as opposed to good, very good, or excellent health – reported having at least one barrier to affordability.

As health deteriorated and the number of coexisting chronic diseases a population suffered from increased, cost barriers increased for those with private insurance.

Of those who had no chronic illness under private coverage, 10 percent had affordability issues. But 14 percent of people with one to two chronic conditions, a quarter of those with three to four chronic conditions, and 42 percent of those with five or more chronic conditions reported facing cost barriers.

Meanwhile, 20 percent of traditional Medicare beneficiaries who reported fair or poor health said they had difficulty with affordability of their care.

The highest cost barrier reported in this population was for people with five or more chronic conditions. Almost one in five (19%) said they had faced financial barriers to care – less than half of the proportion of privately insured seniors with five or more chronic conditions.

In addition, racial disparities in care existed both within and between the traditional health insurance system and populations with private payor coverage.

Affordability concern rates were higher for Caucasians and Hispanic seniors with private payor coverage than with traditional health insurance. There was no significant difference in affordability between the two coverage options for the Black community.

While these differences exist and present a significant distinction between the main public and private coverage options, more than nine in ten Medicare beneficiaries said they were satisfied or very satisfied with the quality of their care and their provider network.

“Our analysis shows that most adults aged 65 and over receiving Medicare have relatively good access to care and are satisfied with the quality of care they receive, consistent with previous analyzes. In addition, adults aged 65 and over benefiting from Medicare report access to care comparable to that of adults insured by the private sector between the ages of 50 and 64, ”the researchers explained.

“These results suggest that Medicare reimbursement rates lower than those of private insurance do not generally prevent adults aged 65 and over from receiving health services.”

These results are consistent with previous studies indicating that Medicare has improved both access to care and affordability for seniors.

A study published in Health Affairs found that once enrolled in Medicare, barriers to accessing care fell by 50.9% and barriers to accessibility fell by 46%. These researchers also found racial disparities in care similar to those found in the KFF study.

Nonetheless, seniors insured by the private sector have advantages. Separate studies have also indicated that Medicare Advantage members may have a lower cost burden than fee-for-service Medicare members.



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