AARP Eye Center
Background
Medicare beneficiaries’ access to health care services is similar to 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 they may need to travel long distances for specialty care.
Nearly all physicians take part in Medicare. Among those who do, about 98 percent agree to accept Medicare fee-schedule amounts as full payment. About 1 percent of non-pediatric physicians opt out of Medicare and do not receive any Medicare payment, directly or indirectly, for any Medicare beneficiaries they treat.
According to research by the Medicare Payment Advisory Commission (MedPAC), Medicare beneficiaries’ access to clinician services in 2021 was similar to that of privately insured people age 50–64, although a somewhat higher proportion of Medicare beneficiaries experienced delays getting appointments. In 2021, 78 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. This is compared with 83 percent of privately insured people age 50–64. For Medicare beneficiaries age 65 and older seeking an appointment for routine care, 67 percent never had to wait longer than they wanted. However, about 18 percent of beneficiaries ages 65 and older who were looking for a new primary care provider reported large problems finding one, up from 14 percent in 2019.
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 MedPAC 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.
Mobile Integrated Healthcare and Treat and Refer programs have been found to be successful in helping to bring services to rural communities, some using individual physicians in partnership with paramedics. These programs are covered through Medicaid and have been proven successful in supporting rural residents' access to care while also reducing emergency room and hospital visits. Medicare has experimented with payment in this area but does not currently permit reimbursement for these programs.
ACCESS TO MEDICARE SERVICES: Policy
ACCESS TO MEDICARE SERVICES: Policy
Improving access
Policymakers should support new and innovative models for increasing the quality of and access to Medicare Services, particularly in rural and medically underserved areas. This should include reducing unnecessary emergency room and hospital visits.
CMS should continue to test these models. Where evidence supports their use, CMS should include these innovations in Medicare.
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 groups that are discriminated against 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 particular communities and potentially disadvantaged populations. This includes beneficiaries in rural areas and U.S. territories and commonwealths. People with disabilities, individuals with low incomes, members of groups that are discriminated against, 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 to improve health care access
Both CMS and the Medicare Payment Advisory Commission should increase research into the causes of access problems, especially those MedPAC identified in its analyses. Particular attention should be given to research that includes older people with multiple chronic conditions, people from groups who are discriminated against, and people with disabilities.