Health Care Costs and Financing

At least one-fourth of older adults will be uninsured at some point during the years preceding eligibility for Medicare

Adults in late middle age who are uninsured may be particularly vulnerable to declining health and function due to their higher prevalence of chronic disease and ineligibility for Medicare. In addition, at least one-fourth of Americans ages 51 to 57 years will be uninsured at some point during the years preceding eligibility for Medicare concludes a study supported by the Agency for Healthcare Research and Quality (HS10283).

David W. Baker, M.D., M.P.H., of Northwestern University, and Joseph J. Sudano, Ph.D., of Case Western Reserve University interviewed a nationally representative sample of 6,065 U.S. adults aged 51 to 57 as part of the National Health and Retirement Study. The proportion of participants who were uninsured at the time of the interviews conducted in 1992, 1994, 1996, 1998, and 2000 was 14.3 percent, 10.8 percent, 9.7 percent, 8.8 percent, and 8.2 percent, respectively. Even though the prevalence of being uninsured declined over the 8-year period, 23.3 percent of the 4,641 participants who completed the 2000 interview stated that they had been uninsured at least once during that time. Only 60 percent of participants were continuously enrolled in private insurance across all five interviews.

Among individuals who were uninsured at baseline, over one-fourth were covered by public insurance by the end of the study. The public insurance safety net is essential for older adults with severe health problems, note the researchers. The ability of this group to get private health insurance coverage is limited because of their restricted employment opportunities and the high cost of individual health insurance policies for people with preexisting conditions.

See "Health insurance coverage during the years preceding Medicare eligibility," by Drs. Baker and Sudano, in the April 11, 2005, Archives of Internal Medicine 165, pp. 770-776.

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