Older Adults Without Medicare: The Hidden Uninsured
December 9, 2024Medicare Provides Much-Needed Protections for Most, But Not All, Older Adults
Medicare provides near-universal coverage for adults aged 65 and over in the United States, accounting for $624 billion in personal health care spending for this age group in 2020. Yet older adults still paid $165 billion out of pocket for personal health care in 2020. Some of this out-of-pocket spending was by the 31% of older adults who have Medicare coverage only and must fill in its coverage gaps on their own. But there are more than 400,000 older adults who lack even Medicare coverage, leaving them and their families to bear high health care cost burdens all on their own.
The consequences of being uninsured in America are well documented, but often overlooked for older adults, because they are generally assumed to be covered by Medicare. But this is not always the case.
Medicare is not available to all older adults and some who are eligible must pay premiums. Adults aged 65 and older qualify for Medicare without premiums based on paying Medicare taxes on their own earnings, or those of a spouse, parent, or child, while working for a certain amount of time (usually at least 10 years). Those who do not qualify for premium-free Medicare are not automatically enrolled and must pay premiums to maintain their enrollment.
As a result of these requirements, a small share of older adults are not covered by Medicare. In 2023, about 5% of people aged 65 or older did not have Medicare – a total of nearly 3 million people. The rates are higher for older adult men (5.5.% of men age 65 and older do not have Medicare, compared to 4.4% of women aged 65 and older) and decrease with age (8% of men age 65 to 74 do not have Medicare, compared to 2% of men age 75 or older).
Not all older adults without Medicare are uninsured. Most are covered through some combination of employer-based coverage, privately purchased coverage, military coverage, veterans’ benefits, or other options. In 2023, approximately 480,000 older adults were uninsured, or about 0.8% of all older adults and 17% of all older adults without Medicare.
Who are the older adults who are uninsured?
Age. About 3 out of 4 uninsured older adults are between the ages of 65 and 74.
Disability. About 1 out of 4 uninsured older adults have a disability.
Sex.
Race and Ethnicity.
Geography.
The top 5 states with the highest rates of uninsurance among older adults include:
Texas (1.9% of older adults uninsured in 2022)
Nevada (1.3% of older adults uninsured in 2022)
California, Florida, New Jersey (each with 1.1% of older adults uninsured in 2022).
The top 5 states with the greatest numbers of uninsured older adults include:
Texas (70,784 uninsured older adults in 2022)
California (63,298 uninsured older adults in 2022)
Florida (49,794 uninsured older adults in 2022)
New York (29,916 uninsured older adults in 2022)
Illinois (17,658 uninsured older adults in 2022)
What options exist for older adults who are uninsured?
Older adults who do not qualify for Medicare without premiums may still be able to enroll if they can pay the premiums. There are some programs available to help people pay Medicare premiums, and potentially some of the other costs of Medicare. These programs, called Medicare Savings Programs, have eligibility rules and application processes that vary by state. In other words, your ability to get and afford coverage – including Medicare coverage – may depend on where you live. The Centers for Medicare and Medicaid Services is working on efforts to improve enrollment in these programs, which they estimate “will save older adults and people with disabilities nearly 19 million hours in paperwork each year and reduce state administrative burden by over 2 million hours annually. These actions together will help an estimated 1.2 million older adults and people with disabilities with limited income afford their Medicare coverage and health care costs.”
As we near Medicare’s 60th anniversary, it’s important to celebrate its success – and to acknowledge that there is more that can be done to ensure all older adults and their families are protected from the devastating effects of being uninsured.