Older Americans report more difficulty affording care than seniors in comparable countries

Although Medicare provides Americans over the age of 65 with nearly universal health insurance coverage, seniors in the U.S. nevertheless face more cost-related access problems than elderly adults in other industrialized countries, according to a recent study.

An international survey by the Commonwealth Fund, conducted in early 2014, found that older Americans are more likely than their counterparts in ten comparable countries to report skipping needed medical care due to costs (19% vs. 6% on average), having difficulty paying medical bills (11% vs. 3% on average), and spending $2,000 or more in out-of-pocket expenses (21% vs. 7% on average).

“Despite Medicare coverage, older Americans have less protection from health care costs, primarily because of high deductibles and copayments, especially for pharmaceuticals, and limitations on catastrophic expenses and log-term care coverage.”

Commonwealth Fund 2014 International Health Policy Survey of Older Adults in Eleven Countries

The Fund surveyed older adults in the U.S. and ten other industrialized countries (Canada, Australia, New Zealand, and seven European countries). These countries’ populations skew older than the U.S. Even so, seniors in these countries were more likely to report being able to get same- or next-day appointments (68% on average, compared to 57% in the U.S.)

Under the Affordable Care Act, private insurance plans in the U.S. must include a cap on patient out-of-pocket costs. Traditional Medicare does not have such a limit, though many beneficiaries buy supplemental coverage or are eligible for Medicaid, which supplements Medicare benefits.

Some of the difference in costs and access may also be attributed to Americans being in worse health: 86% of American seniors reported suffering from two or more chronic conditions, compared to an average of 60% among their counterparts abroad.

Our analysis of data from the National Health Interview Survey found that, across all adults in the U.S., about 1 in 10 (11%) delayed or went without needed medical care because of cost in 2013. But these access problems are much more common among adults in worse health (22%).