High and rapidly growing health care spending in the U.S. is a concern for consumers, employers, tax payers and policy makers. The relatively high prices paid by private insurers is one of the key factors fueling this trend, leading some policy makers to consider whether Medicare rates, or a multiple of Medicare rates, should be used to help control costs and address affordability concerns for people with private insurance. President Biden, for example, proposed during the campaign to establish a “public option” and reduce the eligibility age for Medicare from 65 to 60 to broaden coverage and lower costs. Democratic lawmakers in Congress have proposed similar legislation to provide more affordable health coverage by leveraging Medicare’s lower provider payment rates. However, some question whether a shift toward Medicare provider payment rates might adversely affect access to care and affordability for people who gain or change coverage under these options.
To inform this discussion, this analysis looks at the current experiences of Medicare beneficiaries ages 65 and older with respect to satisfaction and access measures and examines whether privately-insured adults ages 50 to 64 report access or cost problems at higher or lower rates than Medicare beneficiaries 65 and older. We do not attempt to model how shifts in coverage, and associated changes in provider payments, could change provider behavior and potentially impact access to care, the amount of health care services people use, satisfaction among patients, or affordability. This analysis draws on data from the 2018 Medicare Current Beneficiary Survey and the 2019 National Health Interview Survey (See Methods Appendix for additional information. All results reported in the brief are statistically significant).
Our analysis finds:
- Overall, the vast majority of adults 65 and older with Medicare coverage (94%) report being very satisfied or satisfied with the quality of their medical care and the availability of specialists.
- Most privately-insured adults ages 50 to 64 and Medicare-covered adults ages 65 and older report having a usual source of care in a setting other than an emergency department (96% for both insurance groups).
- A somewhat larger share of privately-insured adults ages 50 to 64 (16%) than Medicare-covered adults ages 65 and older (11%) report having cost-related problems, defined as delaying or forgoing medical care due to costs or having problems paying medical bills.
- The affordability gap is wider among adults in relatively poor health: one-third (33%) of privately-insured adults ages 50 to 64 report cost-related problems compared to one-fifth (20%) of Medicare-covered adults ages 65 and older.