Seriously ill Medicare beneficiaries can face considerable financial hardship

By | November 6, 2019

Despite high beneficiary satisfaction with Medicare overall, a new national survey led by researchers from Harvard T.H. Chan School of Public Health, Harvard Business School, and colleagues finds that its coverage gaps may cause considerable financial distress for the most seriously ill patients.

About half reported a significant problem paying medical bills, with prescription drugs posing the most hardship.

The paper is part of a larger study conducted by Harvard T.H. Chan School of Public Health, the New York Times and the Commonwealth Fund, and was published this week in Health Affairs.


The researchers analyzed survey data collected by phone between July 6 and August 18, 2018. The sample included 742 Medicare beneficiaries defined as seriously ill, meaning they had illnesses requiring recent hospitalizations or multiple physician visits.

Among the respondents, 53% reported having a serious problem paying a medical bill of any kind, with 30% reporting difficulty paying for prescription drugs, followed by hospital bills (25%).

Beneficiaries also reported experiencing financial hardships due to the costs of their illness, including using up all or most of their savings (36%) and being unable to pay for necessities such as food, heat and housing (23%). Emotional or psychological distress was reported by 45% of respondents.

The authors wrote that while Medicare is perceived to offer good financial protection compared with commercial insurance, the extent of financial strain among seriously ill beneficiaries was notable and warrants further investigation.

They noted that while high-need, high-cost patients are associated with acute and end-of-life care, the majority of beneficiaries in this survey sample were living at home, and relying on informal help from family and friends — at considerable cost to themselves and their caretakers.


Medicare Advantage plans have demonstrated coverage gaps as well — never an ideal situation to be in, though the right processes and strategies can help to close them.

There are a few ways coverage gaps may occur. According to Katie Kopansky, health optimization economist at consumer-facing health technology company Welltok, gaps can form when Medicare Advantage plans don’t have close relationships with provider groups and health systems. That can mean missed opportunities to partner with the care delivery team to ensure gaps don’t occur in the first place.

Another factor may be plans’ inadequate relationships with their members. If those relationships aren’t strong, plans won’t have the ability to communicate with their members in a meaningful and helpful way.

Communication, and effective messaging, are the cornerstones of ensuring adequate coverage. Failure to meet certain standards can have negative financial implications for the plan itself.

Twitter: @JELagasse

Email the writer:

News Feed