Seriously Ill Medicare Enrollees Are Struggling Financially

More than half of Medicare enrollees who are seriously ill say they have major problems paying their medical bills, especially prescription drug expenses, according to a new analysis.

Despite more than 90 percent of Medicare beneficiaries having some supplemental coverage to help pay for out-of-pocket expenses, 53 percent of patients with serious illnesses said they have trouble paying their medical bills. In a study published this week in the journal Health Affairs, nearly a third (30 percent) of those responding cited prescription drug prices as creating the greatest hardship, while 25 percent said hospitalization costs and 20 percent listed charges for an ambulance or an emergency room visit.

"The results we published are unexpected,” says Robert Blendon, a professor of health policy and political analysis at Harvard University's T.H. Chan School of Public Health. “We just assumed that if you were on Medicare with some kind of wrap-around coverage, that you didn't have medical bill problems,” says Blendon, who has been analyzing public polls on health care for decades. “Turns out they did."

The study defines a seriously ill patient as someone with an illness or chronic condition that required two or more hospital stays and visits to three or more doctors over a three-year period.

While the costs of the medicines needed to treat their serious conditions were the most important financial concern among the respondents, what the survey can't say “is if that's because the various Part D plans aren't paying for certain drugs and people are having to go out and pay for it themselves.” Blendon said the research did not dig into what people's gap coverage or Medicare Advantage private insurance plans paid for, and that these results warrant further investigation.