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Uninsured Older Adults: Implications for Changing Medicare Eligibility

People ages 58 to 63 constitute one of the fastest-growing segments of the U.S. population. Many also face a severe problem: they are unable to afford or access private health insurance, and therefore remain without coverage until they become eligible for Medicare at age 65.

In a new Commonwealth Fund report, Uninsured Older Adults: Implications for Changing Medicare Eligibility, Pamela Loprest and Cori Uccello of the Urban Institute write that this problem is likely to grow as employers continue to reduce coverage for workers. In addition, proposals to raise the Medicare eligibility age could mean that retirees over age 65 will face similar problems in the future.

Individual health insurance premiums are notably higher than employer-sponsored coverage, especially for those with lower incomes. For those below 200 percent of the poverty level, the median percentage of income spent on individual health insurance premiums is equal to 15 percent of family income. Those with incomes above 200 percent of the poverty level spend only 2 percent of family income on individual premiums.

The authors analyze which groups in the 58 to 63 age range are most vulnerable to being uninsured. They find that of the 10 percent of Americans in this age group who are uninsured, 85 percent belong to at least one of four vulnerable groups: those with incomes below the poverty level, those with little or no prior work experience, displaced workers, and people with disabilities.

The authors conclude that a number of strategies could increase accessibility to health insurance for older Americans not yet eligible for Medicare.

The first is targeted employer-related options, which would include extending the allowable period of COBRA coverage and providing health insurance coverage to those who are receiving unemployment compensation.

The second would be to allow ""buy-ins"" to Medicare for older uninsured persons not currently eligible to enroll until age 65.

Finally, the formation of high-risk insurance pools by a public entity would increase access to insurance for individuals with the highest health care costs.

Facts and Figures
  • If the Medicare eligibility age were raised to 67, as some plans propose, 200,000 Americans would become uninsured.

  • In 1985, three-quarters of workers in medium and large firms could continue their health coverage after retirement; in 1993, only half of workers could do so.

  • More than a quarter (28%) of people ages 58 to 63 with non-group insurance pay more than $2,500 in annual premiums. Another quarter pay $1,000 to $2,500 for coverage.

The full report is not available at this time.

Publication Details



Uninsured Older Adults: Implications for Changing Medicare Eligibility, Pamela Loprest and Cori Uccello, The Commonwealth Fund, February 1997