Differences in Out-of-Pocket Expenditures for Healthcare Services Among Medicare Beneficiaries by Demographics

Background/Objectives: Many Medicare beneficiaries often face substantial financial strain due to healthcare costs. This study examined out-of-pocket expenditures for healthcare services by demographics among Medicare beneficiaries in 2019 and 2021. Methods: A repeated cross-sectional study analyzed the 2019 and 2021 Medicare Current Beneficiary Survey Cost Files of beneficiaries aged ≥65 years (2019, n = 6895; 2021, n = 6094). Survey-weighted generalized linear models with a 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 covariates, and to 2021 USD, were conducted to estimate per capita annual out-of-pocket expenditures for healthcare services, excluding premiums. Results: Estimated average per capita annual out-of-pocket expenditures for healthcare services were $2511 in 2019 and $2641 in 2021. Differences in out-of-pocket expenditures were observed among various demographic groups in 2019 and 2021. Non-Hispanic Blacks had lower out-of-pocket expenditures than non-Hispanic Whites in both years (in 2021, $2139 [1761-2517] vs. $2730 [2580-2879]). Beneficiaries aged 65-74 years who were non-Hispanic Black had lower out-of-pocket expenditures than non-Hispanic Whites in the same age group for both years. A significant proportion of non-Hispanic Blacks had lower incomes (in 2021, income < $25,000, 46.1% vs. 17.0%) and more comorbidities (in 2021, comorbidities ≥ 4, 55.6% vs. 44.7%), compared to non-Hispanic Whites in both years. Similar differences in incomes and comorbidities were observed among those aged 65-74 years of both groups. Conclusions: Medicare beneficiaries face substantial out-of-pocket burdens for healthcare services, with persistent demographic disparities. Understanding contributing factors and implementing effective policies/practices are essential to reduce/mitigate high out-of-pocket expenditures for beneficiaries.