More than four in 10 Americans put off medical treatment over the past year because of the cost of living, according to new survey data, while separate research shows that even people with active coverage often struggle to get prescribed medications approved.
The findings come from two reports published Tuesday: a mid-year consumer survey from online health insurance marketplace eHealth, and an analysis of coverage-related access barriers from prescription cost management provider SHARx.
eHealth's survey, based on responses from more than 1,000 Americans, found that 42% say inflation has caused them to skip or delay medical care within the past 12 months, and 64% say inflation has affected their ability to cover basics such as food, clothing and housing.
The gap was wider among people not yet on Medicare, 52% of whom had delayed care over cost, compared with 27% of current beneficiaries.
Pre-Medicare Americans are also bracing for what comes next.
Among that group, 82% say they worry about healthcare costs in retirement, including half who describe themselves as very worried. Nearly half, 47%, underestimate what retirement healthcare typically costs, which eHealth puts at roughly $175,000 per person, and about a quarter expect to spend under $75,000.
Among current beneficiaries, 42% flagged at least one dissatisfaction with their coverage, with 18% pointing to high monthly premiums and 14% to high out-of-pocket costs. A third said their healthcare spending has run higher than they expected before enrolling.
More than a quarter of Medicare Advantage enrollees, 26%, have not used free benefits such as annual checkups, dental cleanings, hearing tests or vision exams, and two-thirds do not realize plan changes are possible mid-year for qualifying reasons such as a move. Separately, 39% of beneficiaries said they would be interested in GLP-1 drugs for weight loss if their plan covered them, though 73% are unfamiliar with the Medicare GLP-1 Bridge program that took effect July 1.
Among pre-Medicare Americans, 76% worry Medicare will not be available to them when they become eligible, and 75% have the same concern about Social Security. Among people already on Medicare, 75% worry the program could fail or that benefits could shrink while they still need coverage.
SHARx, which helps employers and members navigate prescription costs, argues that even confirmed coverage is no guarantee a patient can start or continue treatment.
The company points to prior authorization requirements, step therapy protocols, formulary exclusions and specialty pharmacy restrictions as recurring obstacles, with specialty medications, including oncology and autoimmune treatments, facing the most friction.
"Too often, covered does not mean accessible," said Paul Pruitt, chief growth officer at SHARx. "Patients and families are told the medication is covered on the plan, but that does not mean they can get it without a maze of administrative hurdles. People need to be able to access the treatment they need."
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