Access to Services in Medicare

Background

Medicare beneficiaries’ access to health care services is similar to, or better than, that of privately insured people age 50–64. But, like privately insured individuals, they may face access problems in geographic areas with provider shortages or need to travel long distances for specialty care.

In a 2018 report, the Medicare Payment Advisory Commission (MedPACThe Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy recommendation on the Medicare program. ) found that nearly all physicians take part in Medicare. Among those, about 95 percent agree to accept Medicare fee-schedule amounts as full payment. Less than 1 percent of physicians opt out of Medicare and do not receive any Medicare payment, directly or indirectly, for any Medicare beneficiaries they treat.

The MedPACThe Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy recommendation on the Medicare program. report concluded that Medicare beneficiaries’ access to physician services is similar to, or better than, that of privately insured people age 50–64. In 2017, 80 percent of Medicare beneficiaries age 65 and older who needed an appointment for illness or injury during the prior 12 months reported that they never had to wait longer than they wanted. For those seeking an appointment for routine care, it was 73 percent. However, about 14 percent of beneficiaries who were looking for a new primary care provider reported significant problems finding one.

Reports of access problems in some geographic areas appear to reflect general provider shortages (that is, not just in Medicare). In some cases, beneficiaries must travel long distances for certain specialty care. If MedPACThe Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy recommendation on the Medicare program. analyses identify a national problem, a broader discussion of workforce and payment policies should take place. Even if the problem is localized, it may merit the development of policies to improve beneficiaries’ ability to receive appropriate, high-quality services.

ACCESS TO SERVICES IN MEDICARE: Policy

ACCESS TO SERVICES IN MEDICARE: Policy

Timely monitoring and evaluation

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Payment Advisory Commission should regularly monitor and evaluate beneficiaries’ access to quality care. The care should include physician and other Part B services provided in all settings, regionally and nationally. Access for members of historically disadvantaged groups should be a special focus.

Public information and special populations

CMS should continue making public the Medicare Current Beneficiary Survey data on access, health care utilization, and other relevant information. The agency also should pay particular attention to access problems of special or potentially disadvantaged populations. These include beneficiaries in rural areas and U.S. territories and commonwealths, people with disabilities, individuals with low incomes, members of historically disadvantaged groups, beneficiaries with end-stage renal disease, and people living in institutions such as nursing facilities and in communities where access problems are common because of a shortage of health care personnel.

Research

Both CMS and Medicare Payment Advisory Commission should increase research into the causes of access problems, especially those MedPACThe Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy recommendation on the Medicare program. identified in its analyses. Particular attention should be given to research that includes older people with multiple chronic conditions and people with disabilities.