Elderly beneficiaries enrolled in Medicare plans are more satisfied with their health insurance, have better access to care and are less likely to have problems paying medical bills than people who get insurance through employers or who purchase coverage on their own, according to a study.
Researchers also found that beneficiaries enrolled in private Medicare Advantage plans are less satisfied with their insurance than those with a traditional Medicare plan, and are more likely to experience access problems.
In the study, conducted by researchers with the Commonwealth Fund and published July 18 on the website of the journal Health Affairs, only 8% of Medicare beneficiaries rated their insurance as fair or poor, compared with 20% of adults with employer insurance and 33% who purchased individual insurance on their own.
As the federal government weighs proposals to cut Medicare spending, the analysis, based on results from The Commonwealth Fund Biennial Health Insurance Survey of 2010, suggests shifting Medicare beneficiaries into private plans could put the elderly at greater risk for not getting needed healthcare and being less satisfied with their insurance.
The researchers found that Medicare beneficiaries have better access to care and greater financial protection than adults with private coverage. In 2010, 23% of Medicare beneficiaries went without needed healthcare because of costs, compared with 37% of those with employer coverage. Adults with employer-based insurance (39%) and individual insurance (39%) reported medical bill problems at almost double the rate of Medicare beneficiaries (21%).
Although healthcare access and medical bill problems worsened for adults with all types of coverage over the past decade, according to the study, Medicare continued to provide better coverage during that period.
The researchers found that those with individual and employer-based coverage were far more likely than Medicare beneficiaries to incur high out-of-pocket costs. Of elderly adults with Medicare, 29% reported spending 10% or more of their income on medical costs, compared with 37% of adults with employer-based insurance and 58% with individual insurance. Only 13% of Medicare beneficiaries were unable to pay for basic necessities such as food or rent or used up all their savings to cover medical bills, compared with 27% of adults with employer-based insurance and 33% with individual insurance.
Within Medicare, satisfaction rates differed depending on whether beneficiaries were enrolled in traditional Medicare plans or in Medicare Advantage plans offered by private insurance companies. Of elderly people with Medicare Advantage, 15% rated their insurance as fair or poor, compared with only 6% of those with traditional Medicare coverage.
The researchers also found that although Medicare Advantage enrollees were less likely to spend 10% or more of their income on premiums and out-of-pocket costs, they were more likely to report cost-related access problems than elderly adults with traditional Medicare. Of beneficiaries with Medicare Advantage, 32% reported at least one access problem due to cost, compared with 23% of those with traditional coverage. The authors said that finding may in part reflect Medicare Advantage beneficiaries experiences with private HMO plans that offer lower premiums in return for limited access to a smaller network of providers.
“In the policy debates over the federal budget deficit, the affordability of Medicare and the expansion of health insurance through the Affordable Care Act,” the authors wrote, “listening to the experiences of individuals, whether covered by Medicare or private employer insurance, is important.”
Given the more positive experiences of those covered by Medicare, they wrote, states might want to consider offering traditional Medicare coverage to nonelderly individuals through the state exchanges that are scheduled to begin operating in 2014 as required by the ACA.
“As we expand insurance and move toward near-universal coverage, it is imperative that we ensure health plans provide financial protection and good access to care,” Commonwealth Fund President Karen Davis said in a news release. “The achievements of Medicare in fulfilling the goals of health insurance coverage for beneficiaries can provide important lessons for the entire U.S. healthcare system.”
To read the study, visit http://bit.ly/NA3hQ3.