Evidence Shows Most Medicare Beneficiaries Easily Obtain Health Care

An issue brief from the Kaiser Family Foundation reports that Medicare beneficiaries are experiencing good access to health care—comparable to, and sometimes better than, that of privately insured individuals aged 50-64. Despite talk of significant cuts in Medicare payment for physician services, the majority of Medicare beneficiaries reported having a usual source of care, as well as experiencing short waiting times in scheduling routine and specialty care. The brief, entitled Medicare Patients’ Access to Physicians: A Synthesis of the Evidence, details the findings of multiple patient surveys and physician surveys, as well as published studies and physician data gathered by Medicare.

Usual Source of Healthcare

Ninety-six percent of Medicare beneficiaries report having a usual source of care, with 86 percent saying that their usual source of care is a doctor’s office or a doctor’s clinic, according to the Medicare Current Beneficiary Survey (MCBS). The four percent who reported not having a usual source of care fall into certain vulnerable subgroups such as Medicare beneficiaries without supplemental coverage, Hispanic beneficiaries, beneficiaries with Medicaid, lower-income beneficiaries, and beneficiaries under the age of 65.

Timely Scheduling

Most beneficiaries are able to schedule appointments within a short wait time, with 51 percent reporting appointments within three days and only 12 percent reporting that they have to wait 19 days or more. Appointments with specialists are even easier to obtain, with 92 percent of Medicare beneficiaries and 90 percent of Medicare Advantage beneficiaries saying that it is “always” or “usually” easy to schedule an appointment with a specialist, according to 2012 Consumer Assessment of Health Providers and Systems (CAHPS) surveys. These experiences are similar to those reported by privately insured individuals ages 50-64.

Finding New Doctors

Only 7 percent of Medicare beneficiaries report looking for a new doctor within the last year, and, out of that share, only 1.8 percent report problems in finding a primary care physician (comparable to 1.6 percent of privately insured individuals), according to a 2012 MedPAC patient survey.

Delay in Seeking Care

Less than 10 percent of Medicare beneficiaries report delaying or foregoing medical care when experiencing a medical problem or condition—a lower rate than that of privately-insured individuals, according to the Health Tracking Household Survey (HTHS) by the Center on Health Systems Change. Those likely to delay or forego medical care include beneficiaries under the age of 65 with permanent disabilities, those in poor or fair health, those with at least five chronic conditions, and those with no supplemental coverage. Black beneficiaries and those with lower incomes are also likely to skip seeking care.

Physicians Accepting New Patients

Ninety-one percent of office-based physicians report that they are accepting new Medicare patients—a number similar to patients with private non-capitated insurance, but higher for new patients with private capitated insurance, Medicaid, and charity and no-charge care, according to the 2012 National Ambulatory Medical Care Survey-National Electronic Health Records Survey. Ninety-eight percent of surgical specialists reported accepting new Medicare patients, but only 88 percent of primary care physicians and 88 percent of other medical specialists accept new Medicare patients. Psychiatrists, at 64 percent, are the least likely to accept new Medicare patients into their practice.

Physicians Opting Out of Medicare

Ninety-six percent of physicians registered with Medicare have signed participation agreements stating that they accept the Medicare fee schedule, according to the MedPac analysis. The number of physicians billing Medicare has grown from 525,000 to 549,000 between 2009 and 2011. The ratios of primary care physicians and specialists to beneficiaries has held steady at 3.8 and 8.5 (respectively), but the data does not account for geographic distribution, which may indicate lower physician supply in certain communities. Less than one percent of physicians have opted out of Medicare entirely by signing affidavits with Medicare, according to CMS data. Forty-two percent of physicians who opted out were psychiatrists.