Affordability of Medical Care Among Medicare Enrollees

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Abstract
Medical care in the US frequently requires substantial payments from patients, even if they have health insurance. Ample research has reported that patient cost-sharing is a barrier that prevents many US residents from getting needed care, threatening health goals. Cost-sharing also may result in major medical debt or deplete household resources to the point that people cannot afford other necessities of life.1-5 The Medicare program insures most US residents aged 65 years or older as well as other adults with long-term disabilities or end-stage kidney disease. Medicare enrollees contribute only a small proportion of the total cost of their medical care through premiums and cost-sharing.6,7 Nevertheless, given the relatively large illness burden and modest incomes in this population, even heavily subsidized care can be difficult to afford. Standard Medicare requires payment of an annual deductible ($183 in 2017) followed by 20% coinsurance for physician and outpatient services. The average total out-of-pocket health spending for a Medicare enrollee in 2016 was $5460, including cost-sharing and premiums—nearly half of the average income from Social Security.8,9

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