More than half (53%) of Medicare beneficiaries with serious illnesses struggled to pay medical bills, according to the authors of a recent study.1

“Our motivation for doing this study was to better understand the experience of patients with serious illness,” says Michael Anne Kyle, MS, MPH, the study’s lead author and a doctoral student in health policy and management at Harvard Business School.

Efforts to improve the healthcare delivery system usually focus on high-need, high-cost patients. Kyle and colleagues wanted to study the view through the eyes of these patients. “We were interested in these patients’ own perspectives on their needs and challenges,” Kyle explains.

The paper was part of a larger national study of seriously ill adults.2 After discovering the extent to which Medicare patients were struggling with medical bills, the researchers decided to write a paper on this group specifically.

The findings contradicted the general perception that this patient population is well-protected through a combination of Medicare and Medigap, Medicare Advantage, or Medicare and Medicaid. “We were surprised at the extent of the financial distress reported by Medicare beneficiaries,” Kyle reports.

It was not just that Medicare patients struggled with bills. Part of the issue was that no one had ever talked to them about what they would owe. Fewer than half (46%) of seriously ill patients felt adequately informed by their healthcare providers about what their insurance would cover.

“This has gotten less attention than the financial hardship findings, but it is so important,” Kyle stresses. These other findings showed how ill-informed patients felt about what they would owe:

  • Only 27% said their main doctor discussed cost of care;
  • 27% struggled to understand what insurance covers for a doctor’s visit;
  • 19% struggled to understand a doctor’s office bill;
  • 21% struggled to understand what insurance covers for a hospital stay.

“There is a lot of room for improvement in financial counseling,” Kyle concludes. Patient access can do its part by discussing the cost of care with all seriously ill patients, regardless of their insurance coverage.

“Medicare beneficiaries may not be an obvious population for counseling,” Kyle notes. However, these patients spend about the same out of pocket as the overall patient population. “The top 5% of patients face about half the out-of-pocket costs. This is definitely a key group to do outreach with,” Kyle offers.

Even if medical bills are covered adequately, patients might be struggling with informal caregiving. “Inadequate support at home could be a risk factor for a future admission,” Kyle adds.


  1. Kyle MA, Blendon RJ, Benson JM, et al. Financial hardships of Medicare beneficiaries with serious illness. Health Aff (Millwood) 2019;38:1801-1806.
  2. Schneider EC, Abrams M, Shah A, et al. Health care in America: The experience of people with serious illness. Commonwealth Fund, October 2018. Available at: Accessed Nov. 27, 2019.