Despite Medicare, US Seniors Struggle to Afford Care Compared With International Peers

American seniors face some of the highest health care costs among wealthy nations.

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Older adults in the United States are disproportionately affected by health care costs compared with their counterparts in other wealthy nations, despite the widespread availability of Medicare.¹ Findings from the 2024 Commonwealth Fund International Health Policy Survey of Older Adults highlight significant affordability challenges within the US health care system.

Older Americans spend more out of pocket on health care and are more likely to skip or delay needed treatments due to costs, according to the survey conducted in 10 high-income countries. These financial barriers often lead to worse health outcomes and higher long-term care costs, raising questions about the adequacy of Medicare's coverage.

“This study highlights how vital Medicare is for older adults in the US, but it also underscores the challenge of affording needed care," Gretchen Jacobson, vice president, Medicare, The Commonwealth Fund, said in a statement.² "Rising costs are forcing many older Americans to pay more out of pocket, leading to delayed care, poorer health, and higher long-term spending.”

The 2024 survey involved 16,737 adults aged 65 and older across Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the UK, and the US.¹ Interviews were conducted via telephone and online, with the US sample focusing on Medicare beneficiaries, including traditional Medicare (n = 845) and Medicare Advantage (n = 1037). The margin of error ranged from ±2.3 to ±7.1 percentage points.

Older adults worldwide experience varying degrees of financial burden when accessing health care, with the US and Switzerland standing out for their high out-of-pocket costs. Findings show that in these countries, approximately 1 in 4 older adults spend $2000 or more annually on health care, compared with less than 10% in countries like France, the Netherlands, Sweden, and the UK. In Switzerland, the prevalence of high costs is tied to high-deductible plans and gaps in coverage for services like dental and hearing care, a challenge mirrored in the US system.

In the US, one-third of older adults facing cost-related access issues report fair or poor health. Common barriers include skipping medical tests, avoiding doctor visits, or not filling prescriptions. These issues are far less common in countries like the Netherlands, where almost no older adults report avoiding doctor visits due to cost. Prescription adherence is also notably higher abroad, with the US having double the rate of skipped doses or unfilled prescriptions compared with other countries.

Dental care poses a significant affordability challenge globally, especially in the US, Australia, and Canada, where at least 1 in 5 older adults skip dental visits due to cost, according to survey findings. In contrast, fewer than 5% of older adults in the Netherlands and Germany face similar challenges. While traditional Medicare offers minimal dental coverage, supplemental policies and Medicare Advantage plans provide limited relief, leaving many beneficiaries responsible for significant out-of-pocket expenses.

Mental health services show a more optimistic trend, with affordability being a minor barrier across all countries analyzed. Less than 5% of older adults skipped mental health care due to costs, reflecting the broad inclusion of mental health benefits in national health programs, including Medicare.

Social determinants of health, such as food security and housing stability, also influence care access and outcomes. While fewer than 10% of older adults across countries report unmet social needs, those who do are at greater risk for expensive and intensive medical interventions. The authors pointed to the interplay between financial challenges, social factors, and health outcomes, highlighting the need for comprehensive policy solutions to reduce disparities in health care access and affordability.

The Commonwealth Fund researchers call for policy interventions to improve Medicare's affordability and reduce out-of-pocket costs. They point to other countries in the survey, where comprehensive public health insurance and supplemental coverage mitigate cost barriers and ensure access to care.

“Even though nearly all older adults in the United States are covered by Medicare, this study highlights areas where the program has room to improve," Munira Z. Gunja, senior researcher for International Health Policy and Practice Innovations, The Commonwealth Fund, said in a statement.² "In some countries, almost no older adults are skipping or delaying care because of the cost. The US can look abroad for innovative solutions to protect this age group from high health care costs, such as capping out-of-pocket expenses and fully covering hospital and physician services. Medicare was created to ensure older Americans can get the care they need and afford to stay healthy, and it’s critical that we uphold that promise to them.”

References

1. Gunja MZ, Jacobson G, Leonard F, Williams II RD. Health care affordability for older adults: how the U.S. compares to other countries. The Commonwealth Fund. December 4, 2024. Accessed December 4, 2024. https://www.commonwealthfund.org/publications/issue-briefs/2024/dec/health-care-affordability-older-adults-how-us-compares-other-countries

2. New international survey: older adults in U.S. struggle with health care costs more than those in other nations. News release. The Commonwealth Fund. December 4, 2024. Accessed December 4, 2024.