All of these charges were brought about during my [cancer] treatment. [The hospital] neglected to use my Medicaid insurance along with my Medicare insurance which they have copies of both. I did not receive mailed statements for services rendered and also had no copays for these amounts. As of this writing they still do not do proper insurance billing as it is faster for them to send to [the debt collection company].53
Many consumers report that the underlying debt was the result of the provider’s attempt to bill consumers for amounts beyond the contractual reimbursement rate:
I took a medical test at my specialist’s office two years ago. The charges were covered by my insurance and the specialist’s health system is a “preferred provider." They are required to accept this amount as payment in full. I paid the patient portion in full. The doctor's office has attempted to collect an additional $XXX from me that I do not owe. I have received numerous calls and letters from them, their billers, and an outside collections agency. Each time, I have submitted letters disputing the validity of this debt and provided them with copies of my Explanation of Benefits, which clearly states that I am not responsible for any additional amounts. This has been going on for nearly two years and I am suffering a great deal of stress and anxiety because of the ongoing dispute.54
Older people with both Medicare and Medicaid report high levels of unpaid medical bills despite numerous protections
Nearly 7 million older adults ages 65 and older are enrolled in both Medicare and Medicaid. They are known as dually eligible beneficiaries.55 Most dually eligible beneficiaries should have little or no out-of-pocket costs because they qualify and receive Medicaid assistance with Medicare premiums, coinsurance, copayments, and deductibles for Medicare-covered care.56 Similarly, a majority of dually eligible beneficiaries also receive help with the cost of hearing, dental, and vision care – costs that typically are not covered by traditional Medicare.57
In addition, federal and state laws prohibit providers from billing certain dually eligible beneficiaries58– who, together, account for nearly two-thirds of dual beneficiaries59 – for payment beyond a nominal copay, if any.60
The protections provided to dually eligible beneficiaries are vital, as the vast majority of these individuals have very low income and assets.61 In addition, older dually eligible beneficiaries are more likely than other older adults to report poor health, a wide range of chronic conditions, and limitations with activities of daily living than the general Medicare population age 65 and older.62
Despite these protections, older people with both Medicare and Medicaid are more likely to report unpaid medical bills than the general older population (10 percent vs. 7 percent).63 Furthermore, older dually eligible beneficiaries with unpaid medical bills report, on average, more in unpaid medical bills than the general older population ($15,700 vs. $13,800).64 Among other things,65 these findings suggest that providers are billing older dual beneficiaries for amounts they don’t owe.66
In 2019, the CFPB and Centers for Medicare & Medicaid Services jointly highlighted the illegal practice of billing certain dually eligible beneficiaries for additional amounts that are not owed.67 Unfortunately, dually eligible beneficiaries continue to experience the same inaccurate bills.
Complaints submitted to the CFPB by older dually eligible beneficiaries illustrate how inaccurate billing affects them:
In all the years I have been on Medicare and Medicaid I have never paid for a doctor's visit except for any copay that might be due which was about $3.50… I was billed again and contacted the billing department again and they said the doctor is refusing to update the notations so the right coding can be submitted to Medicare. Today I received a debt collection letter about this bill that should never have been from day one. [Please] file the correct claim with Medicare and…Medicaid to get the bill paid and to remove any negative marks and consumer statements from my profiles. [I want] to never be contacted by this debt collector again.68
In complaints submitted to the CFPB, some dual beneficiaries also report that their claims were never submitted to the state Medicaid agency for payment:
Medicaid was willing to pay for the debt when I first started to receive the bills in 2018. I called the doctors and explained that Medicaid wanted them to [file a claim]. [T]he doctors didn't want Medicaid, they wanted cash money[.] I explained I'm on a fixed income on SSI disability so I called Medicaid back. Medicaid said they can't do anything unless the doctors file a claim. So... the bills went to [a collection agency]. The amount at the time $4900. I checked my credit history and the amount is now $5,130 dollars.69
Inaccurate medical bills that are referred to debt collectors and appear in consumer credit reports may have significant consequences for the health and financial security of older adults
Prior CFPB work has shown that some unpaid medical bills are sent to collectors and reported to credit reporting companies even if they are the result of wrongful billing.70 As of December 2020, the CFPB’s Consumer Credit Panel71 showed $7.97 billion in medical collection tradelines in the credit reports of 5.1 million older adults.72
When inaccurate medical bills are referred to debt collectors and appear in consumer credit reports, older adults experience negative impacts to their credit access and terms. Since some lenders, employers, insurers, landlords, and others still rely on outdated credit scoring models that include medical collections tradelines, incorrect data on medical debt can affect many aspects of the financial lives of older adults.73 As noted, older adults responsible for multiple debts, including mortgages, student loans, and credit card debt, are more likely to report having unpaid medical bills. In complaints related to credit reports, older adults describe how inaccurate medical debt is impacting their access to affordable credit and ability to borrow:
I've been on disability since birth with Medicaid and Medicare my entire life. I have always had a $0 copay. I've been in an ambulance more than once in my life, every other ambulance bill has been paid for in full by my insurance. I have submitted dispute after dispute to Equifax with no success. Now I am being denied every single application again and again. I believe [this bill] has been holding me back from being able to access any sort of relief loans or any line of credit going all the way back for the past 7 years.74
Medical debt can also have significant consequences for older adults’ health and well-being. Older adults with medical debt are more likely to forgo medications, skip doctor’s visits, or learn that healthcare providers refuse to treat them.75 For instance, according to the Federal Reserve Board Survey of Household Economic and Decision-making, 19 percent of older adults with medical debt responded by skipping doctor visits and 17 percent chose not to fill physician-prescribed medication.76 This reduced access to medical care can have devastating consequences if health conditions worsen or fail to improve due to lack of treatment.
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