MEDICARE: Study Says Many Beneficiaries Are At Risk

      Two out of three Medicare beneficiaries have incomes below 200% of the federal poverty level or health problems, which make them more likely to experience financial burdens or problems in obtaining access to care, according to a new report from the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The study was based on telephone interviews with 3,300 Medicare enrollees during 1996 and 1997. More than 14% of respondents reported financial difficulties stemming from medical bills, and nearly 23% of those with incomes below 200% of the federal poverty level reported difficulties accessing health care, compared to only 10% with incomes above 200% of the poverty level. Cost issues weighed especially heavily on the poor, disabled and those not in good health. Twenty-seven percent of Medicare beneficiaries at or below the poverty level, 24% of those in fair or poor health and 30% of those disabled and under age 65 said paying medical bills was "very difficult" or had exhausted all their savings. Further, one in ten respondents reported spending more than $100 a month on medications, with those under 65 and disabled more at risk for higher out-of-pocket prescription drug costs, with nearly 18% paying more than $100 each month for medication. Medicare HMO enrollees and Medicare- only beneficiaries were about twice as likely to report problems with access than those with Medigap or retiree coverage. Dual Medicare/Medicaid eligible recipients were nearly three times as likely to report problems in accessing care than those who had private supplemental insurance.

Looking Elsewhere
      Nearly one in eight Medicare beneficiaries reported enrolling in HMOs, and rated their care at similar levels as those in fee-for- service. In addition, those enrolled in HMOs were more likely to report receiving preventive care than those in fee-for-service: 68% of HMO enrollees reported receiving a mammogram in the past year, compared with 53% of beneficiaries with private supplemental insurance and 40% of those without any supplemental coverage. Further, higher income beneficiaries use the preventive services more than their lower income counterparts. The survey found that 69% of men with incomes 200% above the poverty level reported receiving a prostate screening, compared with 40% of those living in poverty. Karen Davis, president of the Commonwealth Fund, urges the National Bipartisan Commission on the Future of Medicare to "balanc[e] the financial burden on beneficiaries and the need to assure Medicare's financial future. In the drive to slow the growth of federal spending on Medicare, it is important not to lose sight o the financial burdens health care expenses impose on older, sick and less financially secure beneficiaries" (Kaiser/Commonwealth release, 1/5).