Lack of affordability tops the list of health care concerns of older Americans

What weighs most on seniors’ minds when it comes to health care?

Cost of services and therapies and their ability to pay.

“It’s on our minds a lot because of our age and because everything keeps getting more expensive,” said Connie Colyer, 68, of Pleasureville, Kentucky. She is a retired pickup truck operator who has lung disease and high blood pressure. Her husband, James, 70, drives a dump truck and has a potentially dangerous irregular heart rhythm.

Tens of millions of seniors are similarly concerned about being able to afford health care because of its expense and rising costs for housing, food and other essentials.

A new wave of research highlights the extent of these anxieties. When the University of Michigan’s National Survey on Healthy Aging asked people 50 and older about 26 health-related issues, their top three areas of concern had to do with costs: medical care in general, long-term care and prescription drugs . . More than half of the 3,300 people surveyed in February and March reported being “very concerned” about these issues.

In fact, five of the top 10 issues identified as being of great concern were related to cost. Beyond the top three, people cited the cost of health insurance and Medicare (52%) and the cost of dental care (45%). Financial fraud and scams came in fourth (53% very concerned). Of far less concern were issues that receive considerable attention, including social isolation, obesity and age discrimination.

In an election year, “our poll sends a very clear message that seniors are concerned about the cost of health care and will look to the candidates to discuss what they have done or plan to do to curb those costs,” John said. Ayanian. director of the University of Michigan’s Institute for Health Care Policy and Innovation.

Seniors have good reason to worry. One in 10 seniors (about 6 million people) has an income below the federal poverty level. About 1 in 4 rely exclusively on Social Security payments, which average $1,913 per month per person.

Although inflation has moderated since its peak in 2022, prices have not fallen, putting a strain on seniors living on fixed incomes.

Meanwhile, traditional Medicare doesn’t cover some services that millions of older adults need, such as dental care, vision care, or home help from aides. While private Medicare Advantage plans provide some coverage for these services, benefits are often limited.

All of this contributes to a squeeze on health care affordability for older adults. Recently published research from the Commonwealth Fund’s Healthcare Affordability Survey 2023 found that nearly a third of people aged 65 and over reported having difficulty paying for healthcare costs, including Medicare premiums, drugs and co-pays related to receiving medical services.

One in 7 seniors reported spending a quarter or more of their average monthly budget on health care; 44% spent between 10% and 24%. Seventeen percent said they or a family member had given up needed care in the past year for financial reasons.

Colyers in Pleasureville are among them. Both need new dentures and glasses, but can’t afford to pay thousands of dollars out of pocket, Connie said.

“As the cost of living rises for basic needs, it’s harder for low- and moderate-income Medicare beneficiaries to afford the health care they need,” said Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund. Similarly, “when health care costs rise, it’s harder to afford basic needs.”

This is of particular concern because the elderly are more prone to illness and disability than younger adults, resulting in a greater need for care and higher costs. In 2022, seniors on Medicare spent $7,000 on medical services, compared to $4,900 for people without Medicare.

This figure does not include the cost of assisted living or long-term nursing home stays, which Medicare also does not cover. According to the latest Genworth survey, the average annual cost of a semi-private room in a nursing home was $104,000 in 2023, while assisted living reached $64,200 and the value of a week of services from home health aides averaged $75,500. dollars.

Many adults simply cannot afford to pay for these long-term care options or other major medical expenses out of pocket.

“Seventeen million adults have incomes below 200% of the federal poverty level,” said Tricia Neuman, executive director of the Medicare Policy Program for KFF. (That’s $30,120 for a one-person household in 2024; $40,880 for a two-person household.) “For people living on that income, the risk of a large expense is very scary.”

How to deal with unforeseen expenses in the future is a question that haunts Connie Colyer. Her monthly premiums for Medicare Parts B and D, and a supplemental Medigap policy total nearly $468, or 42% of her $1,121 monthly Social Security income.

With a $523-a-month home mortgage and more than $150 in monthly co-payments for her inhalers and her husband’s heart medication, “we wouldn’t make it if my husband wasn’t still working,” she told me she. (James’ monthly Social Security payment is $1,378. His premiums are similar to Connie’s, and his income fluctuates based on the weather. In the first five months of this year, it approached $10,000, he told me Connie.)

The couple does a lot to qualify for programs that help seniors pay Medicare out-of-pocket costs. About 6 million people are eligible but not enrolled in these Medicare Savings Programs. Those with very low incomes may also qualify for dual coverage from Medicaid and Medicare or other types of assistance with housing costs, such as food stamps.

Older adults can check their eligibility for these and other programs by contacting their Area Agency at the Agency, the State Health Insurance Assistance Program, or the benefits enrollment center. Enter your ZIP code in the Eldercare Locator and these and other local senior care organizations will appear.

Convincing older adults to step forward and seek help is often not easy. Angela Zeek, manager of health and government benefits at Legal Aid of the Bluegrass in Kentucky, said many seniors in her area don’t want to be considered poor or unable to pay their bills, a blow to their pride. “What we’re trying to say is, ‘You’ve worked hard your whole life, you’ve paid your taxes. You’ve given back to this government, so there’s nothing wrong with the government helping you out a little.’

And the unfortunate truth is that there is very little, if any, help available to seniors who are not poor but have modest financial resources. While the need for new dental, vision and long-term care benefits for older adults is widely recognized, “the issue is always how to pay for it,” said KFF’s Neuman.

This will become an even bigger issue in the coming years due to the growing aging population.

There’s relief on the horizon, though: Help with Medicare drug costs is available through the Inflation Reduction Act of 2022, though many seniors don’t realize it yet. The act allows Medicare to negotiate the price of prescription drugs for the first time. This year, out-of-pocket costs for drugs will be capped at a maximum of $3,800 for most beneficiaries. Next year, a $2,000 cap on out-of-pocket drug costs will go into effect.

“We’re already seeing people who have had very high drug costs in the past save thousands of dollars this year,” said Frederic Riccardi, president of the Center for Medicare Rights. “And next year, it’s going to get even better.”