Older Black and Latinx Adults Talk About Affordability Challenges

While Medicare offers significant protections for older adults against high health care costs, it does not cover the full cost of care. Out-of-pocket costs, including deductibles and coinsurance for some services, are a burden for Medicare beneficiaries, including many Black and Latinx older adults who have low incomes, complex health needs, and difficulties paying medical bills. To better understand the impact of cost burden and health care affordability, PerryUndem, a public opinion research firm, held 12 focus between July and October 2021 with Black and Latinx Medicare beneficiaries age 65 and older to understand their thoughts on the affordability of health care, among other topics. (For details, see How We Conducted This Study.)

Surprised That Care Remains Unaffordable Under Medicare

Many of the Black and Latinx older adults in our focus groups told stories of being uninsured and struggling to afford care and how they thought enrolling in Medicare would put an end to these worries. They expressed frustration that they must still consider costs before seeking care.

As one participant put it, if care were more affordable, “maybe we’d go for more (doctor) visits. We’d go get the tests we need. I think after working to get your Medicare, at that point you should be able to get your care and it should be affordable.” While more care, particularly unnecessary care, isn’t always better, affordable care helps to ensure that people have access to the care they need.

Cost also plays a role in decisions to enroll in a Medicare Advantage plan or buy a supplemental plan. Some feel they made a good choice, others have regrets and are paying more than they expected.

Many participants explained that costs are not clear when they receive services. They are often caught unaware with large bills to pay. Some feel costs for services are random and vary between providers and facilities. Others believe they are charged higher prices because of their race, income, gender, or type of insurance.

High Costs a Barrier to Care

Participants also discussed how unexpected or high costs caused them to second-guess or delay care. This is consistent with previous research, which has found that roughly 10 percent of traditional Medicare beneficiaries postpone or avoid care because of costs.

Some participants described how the lack of clarity around covered services, costs, and billing caused anxiety or frustration. One woman, who was seeking a diagnostic test, said, “I’m thinking Medicare . . . they’re not going to pay for a second mammogram. And so I was concerned that they wouldn’t and then I would be strapped with a big old bill that I couldn’t afford. And so I haven’t gotten a bill yet . . . . I’m praying I don’t or that I have very minimal to pay, so it is a little anxiety for me.”

Experiences with High Costs Undercut Trust in the Health Care System

Not only do participants feel costs are too high, they also feel it is their responsibility to stay on top of their costs. Many share experiences of questioning bills, checking with their insurance plans, and challenging their providers. As one person put it, “Well now, every time I go to a doctor, I ask him a lot of questions, and I make sure that the cost of the procedure isn’t going to go up. It’s usually at the last minute when they come with the surprise that it’s going to cost you much more. Once you’re there, and they’ve already scheduled the procedure, you don’t have any other choice at that point.” Many say experiences like these lead them to feel providers are taking advantage of them.

Older Adults Want Policy Changes to Make Care More Affordable

In the end, while many are thankful for Medicare and some protection from high costs, older Black and Latinx adults are disappointed to find they still struggle to afford care. Many believe high costs disproportionately impact their communities. They want financial relief and for care to be more affordable.

They believe they themselves play a role in ensuring affordability of care —for example, by being better informed about costs, asking about prices before receiving care, questioning bills, and seeking second opinions or asking for options when treatments are prescribed. But they also want to see the system change. Prescription drug costs are a pain point for many, and most support policies to reduce medication prices. They also want more price transparency to ensure they know upfront how much their care will cost. Some also want health coverage — namely supplemental health plans — to be more affordable and support expansions in affordable health coverage.

Many of the concerns expressed by participants about the affordability and accessibility of care have been longstanding problems within the larger Medicare community because of the gaps in coverage and cost-sharing requirements. These problems may be felt acutely by Black and Latinx enrollees who tend to have lower incomes. The consequences of costly care also may be especially harmful for these beneficiaries; not only are they more likely to report cost burdens when seeking care, as revealed by our focus groups, they also may avoid and postpone necessary care if they cannot afford it. While policymakers examine ways to reduce federal spending for Medicare and shore up the solvency, it is important that patients’ needs and resources are considered. Shifting costs to beneficiaries will only exacerbate existing problems.