No coverage: Many older Americans are one medical bill away from financial ruin

PORTLAND, Ore. — A troubling number of older Americans are just one medical emergency or new health issue away from potential financial ruin, according to a troubling new study by researchers at Oregon Health & Science University. Researchers report a significant amount of older Americans don’t have any health insurance.

More specifically, this latest project found that about a quarter of low-income patients receiving care at community health centers were still uninsured when they turned 65. After reaching age 65, most Americans become eligible for Medicare federal health insurance.

While illnesses and accidents can happen to anyone, older adults are more vulnerable in general to health issues. The added element of low-income patients being more likely to lack insurance only makes these findings more alarming.

“It’s particularly concerning to think of older adults not having health insurance, given that the prevalence of disease and related complications increase with age,” says the study’s corresponding author, Nathalie Huguet, Ph.D., an associate professor of family medicine in the OHSU School of Medicine, in a university release. “It’s more challenging to manage health conditions in the United States without insurance. This can lead to costly hospital stays and avoidable illnesses that require expensive health care services.”

The research team analyzed electronic health record data encompassing over 45,000 patients who became eligible for Medicare between 2014 and 2019. The records covered patients visiting community health centers, which are facilities that provide medical care regardless of a patient’s ability to pay, known to largely serve people of limited financial means.

Upon performing a comprehensive assessment of the data, study authors discovered it was more common for Hispanic Americans to lose their insurance coverage at age 65. Medicare mandates all participants be either American citizens or permanent legal residents, which places the government insurance program out of reach for older undocumented immigrants. Additionally, low income patients may be unable to pay Medicare premiums.

The study also highlights that patients tend to be diagnosed with new chronic health conditions (hypertension, diabetes) upon becoming eligible for Medicare. Roughly 86 percent of patients had two or more chronic health conditions after turning 65 (compared to 77% beforehand). Those who had been uninsured before turning 65 and then gained coverage via Medicare tended to be diagnosed with more new chronic conditions than others who already had insurance before enrolling in Medicare.

“It’s likely these patients unknowingly had chronic conditions for beforehand,” Prof. Huguet explains. “Medicare enables older Americans to receive the essential health care that they need. However, having access to health care earlier in life can also prevent conditions from developing or getting worse as we age.”

All in all, Prof. Huguet and her colleagues hope their work encourages policymakers to provide aging Americans with more support by way of improved access to overall health care and preventive care. Study authors would also like to see community health centers integrate more geriatric-focused care.

The study is published in the Journal of the American Board of Family Medicine.