Average Medicare recipient pays more than $5,000 annually in out-of-pocket costs
Not surprisingly, the age of the Medicare beneficiary plays a large role in their average costs.
As the debate over Medicare for All rages on, a new study from the Kaiser Family Foundation (KFF) offers a timely reminder: our current Medicare system is far from perfect.
The new study analyzes how much Medicare members spend out of pocket on their health care. The study finds that 2016, the average person with Medicare coverage spent $5,460 in out-of-pocket costs. This includes those in community-living programs and those in long-term care facilities.
Related: A new explanation for why U.S. health care spending is so high
Not surprisingly, the age of the Medicare beneficiary plays a large role in their average costs. Medicare members under 65 had $2,834 in out-of-pocket costs; those between 65 and 74 were at $5,021 annually. At ages 75 to 84, beneficiaries paid $5,829 on average, and those over 85 had average out-of-pocket costs of $10,307. The high out-of-pocket costs for those over 85—nearly double that of the next-oldest group—were due primarily to out-of-pocket expenses for services at long-term-care facilities, which are not covered by traditional Medicare.
The study raises an important point about proposed Medicare for All plans: they would be significantly more generous than the benefits under the current system. “Current Medicare-for-all proposals in Congress and from presidential candidates would largely eliminate out-of-pocket costs for premiums and patient cost sharing, including for people now covered under Medicare,” the report notes.
The additional cost of expanding both benefits and coverage as part of Medicare for All is a big part of why the proposals are controversial. As candidates are urged to show their math, the sticker shock that may come with a truly universal, single-payer system has been used to argue that voters are not ready for change on such a large scale. On the other hand, proponents argue that once the current system is replaced, overall health care costs will be lower.
Spending varies by type of beneficiary
The KFF report outlines how out-of-pocket costs can vary significantly for different types of beneficiaries. Besides the question of age, differences arose in other areas as well:
Out-of-pocket spending by women in traditional Medicare was higher than out-of-pocket spending by men ($5,748 versus $5,104).
Beneficiaries with poorer health, those with multiple chronic conditions, and those with any inpatient hospital use faced higher out-of-pocket costs than the average traditional Medicare beneficiary. “Beneficiaries with at least one inpatient stay in 2016 spent $7,613 out of pocket, on average, compared to $5,044 among those without an inpatient stay,” the report said.
Medicare supplemental plans made a difference: those with no supplemental insurance spent more out of pocket than beneficiaries with some type of supplemental coverage. “In 2016, nearly one in five (6.1 million) Medicare beneficiaries did not have any source of supplemental coverage, which placed them at greater risk of incurring high medical expenses. People without any source of supplemental coverage were also more likely to have modest incomes and be ages 85 or older,” the report said.
The unsettled future
The KFF study may lend ammunition to those who argue that switching to a Medicare for All system would simply bring too much change and too much uncertainty around funding. A recent study by the Committee for a Responsible Federal Budget painted a picture of Medicare for All being potentially unaffordable under several scenarios.
In addition, a new Health Affairs report also raises questions about the affordability of the Medicare system currently in place. That study found that more than half (54 percent) of seriously ill Medicare beneficiaries said they’d experienced financial hardships due to high costs of prescription drugs and hospital services.
The KFF analysis noted that fixing the current affordability issues with Medicare will require more government spending, aside from any expansion that may happen in the future.
“The fact that traditional Medicare does not have an annual out-of-pocket limit and does not cover certain services that older adults are more likely to need may undermine the financial security that Medicare provides, especially for people with significant needs and limited income,” the study said. “Addressing these gaps would help to alleviate the financial burden of health care for people with Medicare, although doing so would also increase federal spending and taxes.”
Read more: