Navigating Aging: Lack of affordability tops older americans’ list of health care worries

by Judith Graham
KFF Health News

What are seniors’ biggest concerns when it comes to healthcare?

the cost of services and treatment, and ability to pay;

“We’re constantly worried because of our age and because everything is getting more and more expensive,” said Connie Collyer, 68, of Pleasureville, Kentucky, a former forklift driver who suffers from lung disease and high blood pressure. Her husband, James, 70, is a dump truck driver who suffers from a dangerous arrhythmia.

Tens of millions of seniors are similarly worried about whether they can afford medical care, given the soaring costs of housing, food and other basic necessities.

A new wave of research is shedding light on the impact of these fears. National opinion survey on healthy ageing When people over 50 were asked about 26 health-related issues, their top three concerns were the cost of health care, the cost of long-term care and the cost of prescription drugs. More than half of the 3,300 people surveyed in February and March said they were “very concerned” about these issues.

In fact, five of the top 10 issues identified as of great concern were about cost. Outside of the top three, other issues mentioned were the cost of health insurance and Medicare (52%) and the cost of dental care (45%). Financial fraud and fraud came in fourth (53% were very concerned). Issues that receive a significant amount of attention, such as social isolation, obesity and age discrimination, were less of a concern.

In an election year, “our polling sends a very clear message that seniors are worried about health care costs and they expect candidates to discuss what they have done or plan to do to control health care costs,” said John Ayanian, director of the Institute for Health Policy and Innovation at the University of Michigan.

Seniors have good reason to be concerned: One in 10 seniors (about 6 million people) earns below the federal poverty level, and about one in four rely solely on Social Security benefits, which average $1,913 per person per month.

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

Meanwhile, traditional Medicare doesn’t cover some services needed by millions of seniors, such as dental care, vision care and in-home care by a caregiver. Private Medicare Advantage plans cover some of these services, but benefits are often limited.

All of this is putting pressure on the medical costs for the elderly. Recently published studies According to the Commonwealth Fund’s 2023 Healthcare Affordability Survey, nearly one-third of people age 65 and older report having difficulty paying for health care costs, including Medicare premiums, medications and costs associated with receiving health care services.

One in seven seniors reported spending more than a quarter of their average monthly budget on health care costs, while 44% said they spent between 10% and 24%. 17% said they or a family member were unable to get needed care in the past year due to financial reasons.

That includes the Pleasureville Colliers. They both need new dentures and glasses, but Connie said they can’t afford to pay thousands of dollars out of pocket.

“As the prices of basic necessities rise, it becomes harder for low- and moderate-income Medicare beneficiaries to get the health care they need,” said Gretchen Jacobson, vice president of Medicare programs at the Commonwealth Fund. Similarly, “when health care costs rise, it becomes harder to afford the necessities of life.”

This is especially worrying because older people are more susceptible to diseases and disabilities than younger people, resulting in greater need for and higher costs of care: In 2022, older people with Medicare spent $7,000 on health care services compared with $4,900 for those without Medicare.

That figure doesn’t include the costs of assisted living or long-term stays in nursing homes, which Medicare also doesn’t cover.The median annual cost of a private room in a nursing home in 2023 is $104,000, assisted living is $64,200, and the average cost of a week’s services from a home health aide is $75,500, according to a recent Genworth study.

Many seniors can’t afford these long-term care options or other major medical expenses out of pocket.

“Seventeen million seniors have incomes below 200% of the federal poverty level,” said Tricia Newman, executive director of KFF’s Medicare Policy Program. (That equates to $30,120 for a single-person household and $40,880 for a two-person household in 2024.) “For people living on these incomes, the risk of big expenses is very frightening.”

How to deal with unexpected expenses in the future is a question that worries Connie Collyer. Her monthly premiums for Medicare Parts B and D and Medigap supplemental insurance amount to about $468, or 42% of her monthly income of $1,121 from Social Security.

With a $523-a-month mortgage and more than $150-a-month out-of-pocket costs for an inhaler and her husband’s heart medication, “we wouldn’t be able to get by if he wasn’t working,” she told me. (James’ Social Security payments are $1,378 a month; his premiums are about the same as Connie’s, and his income fluctuates with the weather; in the first five months of this year, it’s approached $10,000, Connie told me.)

The couple’s income is too high to qualify for programs that help seniors pay for their out-of-pocket Medicare costs. As many as 6 million people are eligible for these programs but don’t sign up. Medicare Savings ProgramPeople with very low incomes may also be eligible for dual coverage through Medicaid and Medicare, or other assistance with household expenses, such as food stamps.

Seniors can find out about their eligibility for these and other programs by contacting their local government. Area Agency on Agency, State Health Insurance Assistance Programsor Benefits Enrollment CenterPlease enter your postcode Elderly Care Locator And these and other organizations that support local seniors will spring up.

Convincing seniors to come forward and ask for help is often not easy. Angela Sieg, health and government benefits manager for the Legal Aid Society of Blue Grass, Kentucky, said many seniors in her district don’t want to be perceived as poor or unable to pay their bills, which she said hurts their pride. “What we want to say is, ‘You’ve worked hard, you’ve paid your taxes, you’ve given back to the government, so there’s nothing wrong with the government helping you out a little.'”

And unfortunately, there’s little to no help for seniors who aren’t poor but can’t afford it. The need for new dental, vision and long-term care benefits for seniors is widely recognized, but “the question is always, how do we pay for it,” KFF’s Newman said.

With the rapid increase in the ageing population, this problem will become even greater in the future.

But some relief is on the way. Medicare drug assistance will: Inflation Control Act of 2022Though many seniors aren’t aware of it yet, the law allows Medicare to negotiate prescription drug prices for the first time. This year, out-of-pocket drug costs will be limited to a maximum of $3,800 for most beneficiaries. Next year, there will be a $2,000 cap on out-of-pocket drug costs.

“People who have historically had very high drug costs have already saved thousands of dollars this year,” said Frederick Riccardi, president of the Center for Medicare Rights, “and next year will be even better.”

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