Medicare Recipients Blocked From Receiving Care

A growing number of Americans are being blocked from health care despite being covered under Medicare, a new survey shows.

A yearly KFF Survey of Consumer Experiences with Health Insurance found that while most Americans are satisfied with their Medicare experiences, one group is consistently struggling.

Medicare is generally offered to those age 65 and older, but some Americans are able to get access to the program due to specific disabilities or health conditions. Those with a long-term disability also get coverage, along with those who have end-stage renal disease or amyotrophic lateral sclerosis (ALS).

That means 7.7 million Americans under age 65 get Medicare, which comprises 12 percent of all Medicare recipients. Despite making up more than one in 10 Medicare beneficiaries, this group is not reporting positive experiences.

Nearly all, or 92 percent of those over age 65, gave positive ratings of their Medicare coverage, but only 79 percent of those under 65 with disabilities did.

They were also more likely to report worse access to care, more cost concerns, and lower satisfaction with care, KFF found.

The issues they faced varied, but 70 percent experienced some type of issue with health insurance over the past year, compared to just 49 percent of those 65 and older.

“At least one in five Medicare beneficiaries under age 65 with disabilities who reported problems say they were unable to receive recommended treatment [24 percent] or experienced significant delays in receiving medical care or treatment [21 percent], compared to very small shares of those 65 or older who said the same [6 percent for both],” the survey said.

The reasons for the dissatisfaction are unclear, but since Medicare was initially created to serve older adults, there might be various gaps in the coverage for those younger and disabled.

Those on Medicare under age 65 are also more likely to rate their health as “fair” or “poor,” at about 50 percent compared to just 19 percent of those age 65 and older. Younger Medicare enrollees also are more inclined to report “fair” or “poor” mental health status, while just one in 10 seniors on Medicare do.

“The higher rate of poorer self-reported health among beneficiaries under age 65 could contribute to a higher rate of health insurance problems,” the KFF said.

Differing Health Care Needs

Health care professionals watch the challenges Medicare recipients face every day.

Rhianna Jones, a registered nurse at CanXida, said younger people with disabilities typically have much more complex health care needs compared to older adults.

“While Medicare provides essential health coverage, it may have limitations in coverage for certain services, treatments or equipment crucial for younger individuals with disabilities,” Jones told Newsweek. “Gaps in coverage for rehabilitative services, long-term care, mental health support, or specific therapies can impact their health care experiences.”

Copays and deductibles for uncovered services can also carry a heavy burden on younger Americans as well and potentially limit them from seeking treatment at all.

According to a 2022 Gallup poll, 38 percent of Americans said they or a family member delayed medical treatment due to cost. This was up from just 26 percent in 2021, and the number has been gradually climbing since Gallup first started tracking the percentage.

So what do health care professionals think is the solution? Jones said expanded coverage will be necessary to reduce the financial burden and annoyances that inevitably pop up when undergoing a benefits program not originally built for them.

“Collaborative efforts among policymakers, health care professionals, advocacy groups, and individuals impacted by these disparities are crucial in driving reforms and policy changes aimed at improving the health care experiences and outcomes for younger people and those with disabilities within Medicare,” Jones said.