In the United States, having health insurance is crucial but not enough to guarantee access to affordable medical care. Although the U.S. lacks a universal healthcare system like those in most other wealthy nations, the majority of Americans over 65 are insured through Medicare. However, many still face difficulties in affording care, with high out-of-pocket costs making necessary medications and doctor visits unaffordable for them. According to research from The Commonwealth Fund, a nonprofit dedicated to promoting an equitable healthcare system, these additional costs burden Medicare beneficiaries and make it harder for older Americans to access affordable care compared to their peers in other countries.

Medicare's Affordability Crisis for Older Americans

Medicare and Health Insurance in the U.S.

In the U.S., health insurance is a necessity, yet it doesn't always ensure affordable medical care. Medicare plays a significant role for those over 65, but as the article shows, it still has its challenges. Many older adults struggle with out-of-pocket expenses, which can prevent them from getting the care they need. This is in contrast to other wealthy countries where healthcare systems are more comprehensive and affordable.Research from The Commonwealth Fund highlights the disparity between the U.S. and other nations. Nearly one in four older adults in the U.S. spent at least $2,000 in out-of-pocket expenses last year, while in France and the Netherlands, less than 5% of older adults had such high expenses. Only in Switzerland did older adults report spending more on healthcare than those in the U.S.

Medicare's Coverage Shortcomings

The study suggests that Medicare plans may not be meeting the needs of many Americans. A significant 8% of older adults in the U.S. reported delaying or forgoing medical care due to costs, which is higher than in any other wealthy country except Austria. Not getting the necessary care has consequences; one-third of older U.S. adults who faced cost-related barriers to receiving care reported being in fair or poor health.For example, Medicare Advantage members often find themselves seeing out-of-network doctors, exposing them to substantial healthcare costs. This highlights a flaw in the Medicare system where patients may face unexpected expenses when seeking care.

Mental Health Treatment as an Exception

Interestingly, there is one area where Medicare beneficiaries faced few out-of-pocket costs and were less likely to skip care - mental health treatment. Less than 5% of residents in all nations skipped mental health care due to affordability concerns. This shows that when treatment is affordable, patients are more likely to seek help.It's a benefit that is offered on all health plans, and it demonstrates the importance of making healthcare services affordable across the board.

Solutions for Affordable Healthcare

When older people skip or delay care, their conditions worsen, leading to more costly care and increased federal Medicare spending. Gunja suggests that the U.S. can learn from other countries and implement solutions such as capping out-of-pocket expenses and fully covering hospital and physician services.Across the board, the U.S. generally ranks last in terms of affordability measures. Getting health insurance is essential, but it's just the first step. We need to ensure that coverage is not only comprehensive but also affordable for older adults.