Medicare is a generous program, and the Patient Protection and Affordable Care Act of 2010 (PPACA) has (at least as of press time) made the program more generous yet, by adding zero-deductible coverage for routine preventive care services.
About half of Medicare enrollees fill in the gaps in traditional program coverage that do exist by buying Medicare Advantage plans or Medicare supplement insurance.
Roughly 80% of enrollees hold their annual out-of-pocket expenses to less than $2,000
Here is a look at Medicare enrollees’ out-of-pocket health care expenditures based on a report by Anita Sony and Marc Roemer, researchers at the Agency for Healthcare Research and Quality (AHRQ).
The researchers gave total per-capita 2008 expenditure figures for U.S. adults ages 65 and older who suffered from the five conditions that led to the highest spending totals for the population as a whole. In some cases, these conditions can lead to large amounts of insurance payments and out-of-pocket payments for long-term care as well as for acute care.
The researchers also showed the percentage of the spending on those conditions that came out of seniors’ own pockets.
We multiplied the per-capita spending figures by the out-of-pocket percentage numbers to produce the following results.
1. Trauma-related disorders: $161 in out-of-pocket costs per patient
Older people are certainly less likely than younger people to ski or skydive, but they may suffer broken bones and other traumatic injuries as a result of activities as simple as going out for a walk and slipping.
The United States spent about $20 billion on care for 5.5 million seniors’ trauma-related disorders in 2008.
Those seniors picked up only 4.3% of the tab for trauma care out of pocket; Medicare paid 78% of amounts paid for the seniors’ trauma-related care.
2. Hypertension: $167 in out-of-pocket costs per patient
(Graphic courtesy of AHRQ)
The United States spent a total of about $24 billion in 2008 on hypertension care for almost 24 million seniors with high blood pressure.
The cost of medications for treating hypertension is high.
The cost of treating the consequences of poorly managed hypertension — kidney disease and strokes — is much higher.
Older people with high blood pressure ended up paying 17% of the cost of responding to their condition out of their own pockets.
Medicare covered only 55% of the total cost of handling high blood pressure.
Next: Which seniors with high out-of-pocket costs may never have guessed that coping with their condition would be so expensive?
3. Osteoarthritis: $199 in out-of-pocket costs per patient
The causes of the “aches and pains of growing older” are not well understood, but the financial burden caused by osteoarthritis is clear.
The United States spent $25 billion on the 13 million seniors who reported expenditures on treatment for the condition in 2008.
Medicare did pick up 60% of the tab, but patients had to pay 11% of the billed amount out of pocket, and those payments on medications and other treatments that may or may not have provided relief added up.
Poorly managed osteoarthritis can interfere with the ability of seniors who are in complete control of their faculties to get out of bed, dress and leave the house. The condition may increase the risk that seniors who, mentally, belong in the thick of the action will end up needing formal long-term care.
4. Heart Disease: $222 in out-of-pocket costs per patient
(AP Photo/Toby Talbot, File)
The United States spent $48 billion on treating heart disease in 13 million seniors in 2008.
Medicare paid more than 87% of the seniors’ heart disease tab, and patients paid about 16%.
5. Cancer: $245 in out-of-pocket costs per patient
(National Cancer Institute Photo)
The United States spent $32 billion on care for 8 million seniors with cancer in 2008.
The country spent an average of $4,028 per person on the condition.
Medicare paid 64% of the bills and patients paid 6% out of pocket.