Access to Services in Medicare

Background

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). . Among those, about 95 percent agree to accept MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). fee-schedule amounts as full payment. Less than 1 percent of physicians opt out of MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). and do not receive any MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). payment, directly or indirectly, for any MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries’ access to physician services is similar to, or better than, that of privately insured people age 50–64. In 2017, 80 percent of MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). ). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services (CMS) and the MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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 MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). 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.