Cost and Access Challenges: A Comparison of Experiences Between Uninsured and Privately Insured Adults Aged 55 to 64 with Seniors on Medicare

Cost and Access Challenges: Uninsured and Privately Insured Adults Aged 55 to 64 Compared with Medicare Seniors

Kaiser Family Foundation Issue Brief | May 2012 | By Tracy Yee, Peter J. Cunningham, Gretchen Jacobson, Tricia Neuman, and Zachary Levinson

Near-elderly Americans aged 55 to 64 who lacked health insurance faced severe barriers to medical care, according to joint research by the Center for Studying Health System Change and the Kaiser Family Foundation. Using data from HSC's 2010 and 2007 Health Tracking Household Surveys and the 2003 Community Tracking Study Household Survey, researchers found that four in 10 uninsured near-elderly adults reported having unmet health care needs or delaying necessary treatment. Three in 10 uninsured individuals in this age group lived in families that struggled to pay their medical bills, largely because of out-of-pocket costs.

Insurance Status Makes a Large Difference

Medicare beneficiaries and near-elderly adults with private insurance reported significantly lower rates of access problems compared with their uninsured counterparts, even after statistical adjustments for differences in demographics and health status. This gap highlighted the protective effect of insurance coverage for a population increasingly likely to have chronic health conditions requiring regular medical attention.

The 55-to-64 age group occupied a particularly vulnerable position in the U.S. health system. Too young for Medicare eligibility but old enough to face rising health care needs, these individuals were often caught between declining employer coverage and the high cost of individual market insurance. Those who lost jobs or saw employers drop retiree benefits found themselves without affordable coverage options during a period of life when medical needs were increasing.

Types of Access Problems Documented

The study measured access problems along several dimensions, including inability to obtain needed care, delays in seeking treatment, and financial hardship from medical bills. Across all measures, uninsured near-elderly adults fared substantially worse than those with either private coverage or Medicare. The disparities persisted even when researchers controlled for the generally poorer health status of uninsured individuals, suggesting that lack of coverage itself -- rather than just underlying health differences -- drove the access gap.

Policy Context

The findings underscored the importance of coverage expansion efforts for near-elderly adults, a group that stood to benefit significantly from the Affordable Care Act's insurance market reforms and premium subsidies. As one of the age groups most likely to be denied individual coverage or charged prohibitively high premiums under pre-reform rules, adults approaching Medicare eligibility had strong reason to value guaranteed issue, community rating and subsidized exchange coverage.

Sources and Further Reading

This analysis was published jointly by the Center for Studying Health System Change and the Kaiser Family Foundation, using data from multiple rounds of HSC household surveys.