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Medicare patients have good healthcare experiences, fueling universal coverage debate

The Commonwealth Fund found that Medicare enrollees have healthcare experiences similar to those of their peers abroad, calling into question how the federal program could improve experiences for all patients.

Sara Heath
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Published: 12 Oct 2026

Adults over 65 in the U.S. have healthcare experiences that are about on par with the rest of the developed world, a new finding that's in stark contrast with the nation's international standing for adults aged 18-64.

The analysis, conducted by researchers at the Commonwealth Fund, could make the argument for a universal, Medicare-like insurance option in the U.S. However, issues like a flagging social safety net for younger adults and provider shortages could affect such a system, the researchers acknowledged.

Using data from the Commonwealth Fund's 2024 International Health Policy Survey of Older Adults, which included 10 nations similarly developed to the U.S., the researchers found older Americans actually enjoy better healthcare access compared to those in peer nations.

Healthcare access was measured by having a usual source of care, which 97% of American adults aged 65 and older have. The U.S. also performs well in the number of Medicare members receiving same-day care, quick responses to questions and easy access to after-hours care. The U.S. is the top performer in health IT utilization and use of mental health services for older adults.

The Netherlands was close behind the U.S., while Germany, New Zealand, Switzerland and the U.K. were all above or in line with the 10-country average.

Additionally, Medicare members in the U.S. had the best delivery of care, as measured by factors such as access to preventive care, patient engagement and experience of care, state of care and care coordination.

Australia was close behind, and New Zealand, Canada and Switzerland were all in line with or above the 10-country average. Sweden performed the worst in this domain.

These positive experiences of healthcare delivery culminate in better self-reported health status, the report continued. Four in 10 (41%) older adults in the U.S. described their health as "very good" or "excellent," the same proportion as in Canada. Half of New Zealanders described their health as "very good" or "excellent."

This was a somewhat surprising finding, the researchers said, considering the high rate of complex chronic illness among older adults in the U.S. However, this could be attributed to the better quality of care Medicare members reported, the team explained, or the financial incentives many providers in the U.S. have for flagging chronic illness.

U.S. falls short in healthcare spending, health disparities

The U.S. does underperform in some of the typical areas, including costs. After Switzerland, the U.S. is the poorest-performing country in terms of costs for seniors, which was measured as having no cost-related healthcare access problems, no skipped care due to costs and out-of-pocket costs under $1,000 U.S. dollars.

The researchers said high spending among Medicare members is mostly due to high premiums, point-of-care cost-sharing and uncovered services, such as long-term care. Additionally, for the half of Medicare enrollees who have Traditional Medicare, there is no annual cap on how much an enrollee can be charged out of pocket.

There's also the question of health disparities, the researchers pointed out. Perhaps not surprisingly, the U.S. is home to the biggest income-based health disparities in the developed world.

Income-based health disparities are primarily driven by stark disparities in self-reported health status and perceptions of fair treatment, along with moderate gaps in cost-related barriers to healthcare access.

U.S. has an age gap in healthcare experiences

Findings that Medicare-aged adults in the U.S. have healthcare experiences on par with -- or even better than -- those in peer nations stand in stark contrast to the experiences of younger Americans.

Earlier this year, the Commonwealth Fund published data showing that America is behind its peers on health insurance coverage, health outcomes and healthcare delivery. The nation is also a significant outlier in healthcare affordability.

It could be the Medicare program that differentiates healthcare experiences for older Americans from those of their younger peers, the researchers posited. The Medicare program helps close gaps in uninsurance and underinsurance and ensures access to more comprehensive and standardized coverage.

Moreover, adults enrolled in Medicare don't have to navigate narrow networks; most U.S. doctors accept Medicare. Younger adults on Medicaid or private insurance are more likely to encounter a provider who doesn't accept their insurance -- if they're insured at all.

Meanwhile, Medicare's financial incentives for delivering quality outcomes and strong patient engagement likely improve overall member experience among older adults. That, plus access to a larger social safety net addressing social determinants of health, could contribute to higher self-reported health status among older adults.

But Medicare is not a panacea, the report authors cautioned. Medicare members still faced the highest healthcare costs in the developed world, plus the worst income-based health disparities.

Still, the researchers did question whether universal Medicare-like coverage would improve healthcare experiences for all Americans. While that type of coverage could close the uninsured gap and ensure everyone has high-quality insurance coverage, it could also strain the healthcare system to the point that it cannot improve care for younger Americans.

"Nevertheless, this study strongly suggests that universal access to affordable health insurance is likely to improve the overall performance of the U.S. health care system," the researchers concluded.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.

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