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Patient Financial Responsibility Burdens Affect Pre-Medicare Crowd

Adults between ages 50 and 64 not yet eligible for Medicare coverage are more likely to report patient financial responsibility problems than their older, sicker counterparts.

The rising cost of healthcare and increases in patient financial responsibility continue to be a burden for older adults, with between a quarter and a third of folks over age 50 saying they need to go without basic needs in order to pay for their medical care, according to new surveying from Gallup Poll and West Health.

Specifically, about a quarter of adults over age 65 said they go without basic needs—food, clothing, and utilities—in order to pay for their medical needs. This problem is worse for individuals between ages 50 and 64, with three in 10 reporting they go without basic lifestyle needs to pay for healthcare.

This trend for 50- to 64-year-olds is likely because this population is not yet eligible for Medicare coverage but still faces heightened medical needs as they begin to age.

The poll, which included a nationally representative Gallup Panel of more than 6,500 people, underscored the problems rising healthcare costs are causing. Increased costs can lead to increased patient financial responsibility and out-of-pocket spending, and ultimately affordability problems.

Healthcare affordability problems beleaguer all adults over age 50, likely because these adults are facing increasing medical problems and need to utilize healthcare more often. About half of adults over age 65 said medical costs are at least a minor burden in their life (51 percent), and 15 percent of them said healthcare costs are a significant burden. This comes even as a whopping 94 percent of folks over age 65 have some level of insurance coverage through Medicare.

Those high healthcare costs are translating into healthcare access problems. For example, treatment access—actually visiting a provider—was out of reach for 12 percent of respondents or their family members, which equates to roughly 6.5 million Americans, Gallup and West Health said. Another 11 percent said they or someone in their family rationed or skipped prescriptions to save money. That shakes out to about 6 million people, the poll administrators pointed out.

That’s a precarious situation for anyone; a patient who ignores a medical problem due to cost will likely only see that problem get worse, increasing the odds they need a more intensive, acute intervention that will cost them and their payers even more.

But it’s not just access to a doctor that costs are impeding. The Gallup and West Health survey showed that a quarter of older adults over age 65 are going without basic lifestyle needs, like food and clothing and utilities, because they need to pay their medical bills.

Particularly, 9 percent cut down on food spending, 13 percent on over-the-counter drugs, 6 percent on utilities, and 19 percent on clothing, the survey showed.

Some of these basic needs are key social determinants of health; it’s hard for an older adult to manage a chronic illness when that adult cannot afford groceries or utilities like heat and air conditioning. Patient wellness may deteriorate as folks continue to choose between healthcare access and their basic lifestyle needs.

Matters get worse for pre-Medicare population

The rising cost of healthcare and patient financial responsibility is particularly burdensome for adults ages 50 to 64, many of whom are facing increasing medical needs but who do not yet qualify for Medicare coverage. Some of these patients therefore have flimsy payer coverage or no coverage at all, increasing their out-of-pocket price burden and creating greater financial stress than those with the Medicare safety net.

For example, more pre-Medicare people are concerned about their healthcare costs, with 45 percent reporting such compared to 37 percent in the over-65 crowd. More of those under age 65 said that healthcare costs are a major financial burden (24 percent versus 15 percent), too.

And ultimately, that’s causing more of the 50-to-64 population to skip medical care. About a quarter (26 percent) said they went without healthcare access because of high costs, more than double the number of over-65 people who said the same.

Three in 10 people under age 65 also said they are skipping basic lifestyle needs to pay for their healthcare, which is more than the 24 percent of over-65 people who said the same. A quarter of folks ages 50 to 64 are cutting back on clothing costs, while 15 percent are going without over-the-counter medications, 14 percent without food, and 8 percent without utilities.

Gender and racial disparities at play

In addition to differences based on age, some gender and racial health disparities emerged in the survey data. For example, women both older and younger than 65 were more likely to say they have to ration spending on basic lifestyle needs than their male counterparts. Similar trends emerged for Black adults younger and older than age 65, the survey showed.

These disparities, plus the steep cost-related barriers that affect all patients, may prompt healthcare policymakers to assess further solutions, the survey administrators wrote.

“Policymakers urgently need to grapple with how to improve efficiency and reduce costs of healthcare and prescription drugs in the United States, so Americans do not need to sacrifice basic needs to pay for healthcare or medicine -- or to avoid care entirely because it is too expensive,” they said.

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