Medicare Leads 10 Countries on Access to Care but Lags on Affordability

Older adults with Medicare report some of the best experiences with access to and delivery of care among 10 high-income countries, but they still face more cost-related barriers and higher out-of-pocket spending than older adults elsewhere, according to a new Commonwealth Fund analysis. The report published October 8 by Evan D. Gumas and David Blumenthal, MD, uses the Commonwealth Fund’s 2024 International Health Policy Survey of Older Adults. The survey reached 16,737 adults 65 and older in 10 countries in 2024. US respondents were limited to Medicare enrollees (n = 1882). The authors looked at 28 measures across affordability, availability of care, care delivery, health status, and income-based disparities.¹

Patient Gap in Affordability

Medicare beneficiaries reported more cost-related access problems and higher out-of-pocket spending than their peers abroad. The authors attribute high out-of-pocket spending mainly to premiums, cost sharing at the point of care, and services Medicare does not cover, such as long-term care. Traditional Medicare, which covers about half of beneficiaries, also has no annual out-of-pocket cap. The UK and the Netherlands performed best on affordability.

AJMC® reported on an earlier analysis of the same survey and noted that about 1 in 4 older adults in the US and Switzerland spent $2000 or more annually on health care, compared with less than 10% in France, the Netherlands, Sweden, and the UK. The US also had double other countries’ rates of skipped doses or unfilled prescriptions.²

Older Americans also had the largest income-based disparities in care experiences. Income-related gaps in cost-related access problems were most significant in the UK and the US. In the UK, the authors said these gaps appear to reflect limited access to NHS dentistry and broader cost-of-living challenges.¹

Medicare Access and Care Delivery

Medicare beneficiaries ranked highest overall on availability of care, just above the Netherlands, with 97% reporting a regular doctor or place of care. They also reported the highest rates of mental health treatment and use of online tools to communicate with providers. Medicare enrollees also reported the best experiences with care delivery. This area includes preventive care, patient engagement, safe care such as medication review, and coordination among primary care providers, specialists, and hospitals. Older adults in the US and Australia reported the highest rates of care coordination, and those in Sweden and France reported the lowest.

US respondents were more likely than their peers to report 3 or more chronic conditions. However, New Zealanders and US respondents had the lowest rates of fair or poor self-reported health. The authors said this could reflect better care or more aggressive diagnosis, which Medicare Advantage plans have financial incentives to pursue.

Significant Contrast with Younger Americans

In 2023 survey data US adults aged 18 to 64 fell at or near the bottom on nearly every measure. Only 84% of younger US adults had a regular source of care, comparable to Canada and Sweden at the low end. The gap between older and younger adults was larger in the US and UK than in any other country surveyed.

Possible explanations, the authors suggest, include universal eligibility, broad provider acceptance, incentives for higher-quality care, and Social Security and other safety-net support. They caution that the findings cannot predict whether Medicare-like coverage for everyone would significantly improve system performance, noting primary care workforce limits. Additionally, they conclude that universal access to affordable insurance would likely improve US health system performance. The report also notes that recently introduced legislation has proposed capping traditional Medicare spending for Parts A and B at $5000 a year.

References

1. Gumas ED, Blumenthal D. How the experiences of older adults on Medicare compare to the experiences of older adults abroad. Commonwealth Fund. October 8, 2026. doi:10.26099/0mvx-xz23
2. Grossi G. Despite Medicare, US seniors struggle to afford care compared with international peers. AJMC®. December 4, 2024. https://www.ajmc.com/view/despite-medicare-us-seniors-struggle-to-afford-care-compared-with-international-peers