Quarter of Low-Income Older Americans Lack Health Insurance

A new study led by Oregon Health & Science University uncovers gaps in health insurance coverage for older Americans, who have greater health difficulties than the general population.

The study, which was published in the Journal of the American Board of Family Medicine, discovered that around a quarter of low-income patients receiving care at community health centers are uninsured when they reach the age of 65, when most Americans become eligible for Medicare federal health insurance.

“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,” said the study’s corresponding author, Nathalie Huguet, Ph.D., an associate professor of family medicine in the OHSU School of Medicine. “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.”

Huguet and colleagues studied electronic health record data for over 45,000 people who became Medicare eligible between 2014 and 2019. The records came from patient contacts at community health centers, which provide care regardless of a patient’s ability to pay and mostly serve persons with low income.

Their extensive data analysis revealed that Hispanic Americans were more likely to lose insurance coverage at the age of 65. Medicare requires participants to be either U.S. citizens or permanent legal residents, making government insurance inaccessible to unauthorized immigrants. Furthermore, low-income people may be unable to afford Medicare premiums.

The researchers also discovered that people who become eligible for Medicare are more likely to be diagnosed with new chronic health disorders such as diabetes or high blood pressure. After the age of 65, around 86% of the patients in the research had two or more chronic health issues, compared to 77% before. Patients who were uninsured before enrolling in Medicare were diagnosed with more new chronic diseases than patients who had insurance prior to enrolling in Medicare.

“It’s likely these patients unknowingly had chronic conditions beforehand,” Huguet said. “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.”

Huguet and her colleagues hope that their findings may motivate policymakers to better help aging Americans by enhancing their overall access to health care and, in particular, preventive care access. They also hope that it will inspire community health centers to provide more geriatric-focused care.

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