Seriously Ill Medicare Beneficiaries Struggle With Financial Hardship

Among all respondents, 53% of beneficiaries reported having had a serious problem paying a medical bill of any kind. Thirty percent of respondents said prescription drugs created the largest burden.

A national survey published this week in Health Affairs reveals the extent to which financial hardship is affecting seriously ill Medicare beneficiaries, with prescription drugs posing the greatest burden.

The survey was released the same week that the Trump administration reportedly will not consider a drug pricing proposal from House Speaker Nancy Pelosi, D-California, that would give Medicare the authority to regulate drug prices.

The phone survey in the current study was conducted between July 6 and August 18, 2018. Among all respondents, 53% of beneficiaries reported having had a serious problem paying a medical bill of any kind. Thirty percent of respondents said prescription drugs created the largest burden, followed by bills for hospitals (25%), ambulances (20%), and emergency department visits (20%).

Those costs have consequences on the rest of their lives, respondents said, such as plowing through most of their savings (36%), being contacted by a collections agency (27%), and not being able to afford food, heat, and housing (23%).

In addition, the financial struggles reported by these ill beneficiaries included emotional or psychological distress (45%) and problems caring for a dependent (24%).

The survey asked questions of people enrolled in both traditional fee-for-service Medicare as well as those in Medicare Advantage and also those dually enrolled in both Medicare and Medicaid. Interestingly, there was significant differences between beneficiaries who were and were not dually enrolled.

The report notes that 55% of all high-need patients are 65 or older. Other studies have reported that high-need, high cost conditions such as dementia and cancer lead to high out of pocket costs.

Even if a patient’s level of medical need remains constant, healthcare costs have been outpacing inflation. In addition, while advances have led to increased efficacy in treating many diseases, the advances come with a high price tag.

The authors said this is the first report to look specifically at seriously ill Medicare beneficiaries.

The list of conditions affecting beneficiaries included the following:

  • Diabetes requiring insulin
  • Heart disease, heart failure, or myocardial infarction
  • Cancer (other than skin cancer)
  • Stroke
  • Anxiety or depression
  • Opioid addiction
  • Serious injury or accident
  • Composite “Big 4,” or 1 of 4 prevalent, high-morbidity illnesses: diabetes requiring insulin; heart disease, heart failure, and heart attack

The sample included 742 Medicare beneficiaries; 607 answered the questions directly, and proxies, such as spouses, responded for the remaining 135 beneficiaries. The response rate was 21% (margin of error, ±4.6%).

Dual enrollees were significantly younger, less likely to be white, more likely to be black or Hispanic, and more likely to be low-income compared to those not dually enrolled.

Dual enrollees were also more likely to have difficulties with comprehending what insurance would cover for hospital admissions, but less likely to receive a bill afterwards.

Overall, only 46% of the seriously ill felt adequately informed by health professionals about what costs their insurance would cover.

Relatives of the seriously ill were also affected by the cost burden, the results showed; 25% of the seriously ill said that costs were a major burden on their family, while 30% reported a minor burden. The majority of respondents—60%—said family and friends helped. But the ramifications of providing help included their own financial problems: lower income, lost or changed jobs, or reduced hours. Other types of burdens included emotional stress.

Distinguishing the type of burden among different types of Medicaid beneficiaries is an important area for future research, the authors said.

The Commonwealth Fund supported the study.


Kyle MA, Blendon RJ, Benson JM, Abrams MK, Schneider EC. Financial hardships of Medicare beneficiaries with serious illness. Health Aff (Millwood). 2019;(38)11: 1801-1806. doi: 10.1377/hlthaff.2019.00362.

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