OBJECTIVES: Medicare covered approximately 63 million beneficiaries in 2019. About 25% of beneficiaries had annual incomes below $17,000. Many older adults with health care needs can incur significant out-of-pocket expenses. Therefore, this study estimated out-of-pocket spending by sex, age, and race/ethnicity among Medicare beneficiaries aged ≥65 years. Results may provide insight into affordability issues and financial burden faced by many Medicare beneficiaries, despite having health insurance coverage.

METHODS: We analyzed the 2019 Medicare Current Beneficiary Survey Cost Supplement Microdata, a nationally representative sample of community-dwelling Medicare beneficiaries aged ≥65 years (n=6,895, weighted n=48.4 million). A survey-weighted generalized linear model with log link and gamma distribution, with a three-way interaction of sex (male, female), age (65-74, ≥75), and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Other), adjusted for comorbidities and health care utilization, was used to estimate annual out-of-pocket spending of 8 events (i.e., inpatient, provider, outpatient, prescription drug, home health, vision, dental, and hearing care).

RESULTS: Of study beneficiaries, estimated average per person annual out-of-pocket spending for these services was $2,368 (in 2019 dollars). The estimated annual out-of-pocket spending was $2,390 for male beneficiaries and $2,353 for female beneficiaries. Beneficiaries aged 65-74 years spent an estimated $2,316 and those aged ≥75 years spent an estimated $2,443 out-of-pocket on these 8 services. Non-Hispanic White beneficiaries spent $2,469, while non-Hispanic Black, Hispanic, and Other beneficiaries spent an estimated $1,870, $2,025, and $1,936, respectively. When analyzed by sex, age, and race/ethnicity, female beneficiaries aged ≥75 years-Other race spent the least amount out-of-pocket for these services ($1,447), while male beneficiaries aged ≥75 years-Other race spent the most ($3,029).

CONCLUSIONS: Out-of-pocket spending for health care services can be a significant financial burden for different groups of beneficiaries. Implementation of health policies and practices that help lower out-of-pocket spending, particularly for low-income beneficiaries, should be emphasized.