THE COMMONWEALTH

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New Evidence on Health Coverage For Aging Boomers: Findings from

the Commonwealth Fund Survey of Older Adults

Sara R. Collins, Ph.D.The Commonwealth Fund

NASI 18th Annual ConferencePanel on Disability, Social Insurance,And Health Coverage at Older Ages

Washington, D.C. – January 20, 2006

THE COMMONWEALTH

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Figure 1. Chronic Health Conditions* by Income Among Older Adults in Working Families

*Chronic health conditions include hypertension/high blood pressure, heart disease/heart attack, cancer, diabetes, arthritis, or high cholesterol.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

62 62626265

0

25

50

75

Total <$25,000 $25,000-

$39,999

$40,000-

$59,999

$60,000+

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Figure 2. Source of Insurance Coverage by Income

*Difference across income is statistically significant at p ≤ 0.05 or better.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

79

90

81

75

48

8

6

11

10

5

4

4

2

5

18

11

29

4

2

8

0% 25% 50% 75% 100%

Total

$60,000+

$40,000- $59,999

$25,000- $39,999

<$25,000

Employer Individual Medicaid and Other Uninsured

*

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Figure 3. Insurance Instability Among Older Adults in Working Families

*Difference across income is statistically significant at p ≤ 0.05 or better.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

8

2911 4

5

12

87

7

13

14

7

0

25

50

75

Total <$25,000 $25,000-

$39,999

$40,000-

$59,999

$60,000+

Insured all last year, time uninsured since age 52

Insured now, time uninsured in past year

Uninsured now

20

54*

33

18

72

3

2

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Figure 4. Annual Premiums Among Older Adults in Working Families

*Difference across insurance coverage is statistically significant at p ≤ 0.05 or better.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of insured adults 50-64 not on Medicare who are employed or whose spouse is employed

12 11277

28

5

0

25

50

75

Total Insured Employer Individual

$6,000 or more

$3,600-$5,999

19 16*

55

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Figure 5. Annual Deductibles Among Older Adults in Working Families

*Difference across insurance coverage is statistically significant at p ≤ 0.05 or better.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of insured adults 50-64 not on Medicare who are employed or whose spouse is employed

12 13 13

11 8

48

0

25

50

75

Total Insured Employer Individual

$1,000 or more$500-$999

23

61

21*

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Figure 6. Annual Out-of-Pocket Medical Expenses** Among Older Adults in Working Families

*Difference across insurance coverage is statistically significant at p ≤ 0.05 or better.

**Including prescription drug expenses.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

20 1930 26

7 12

23

0

25

50

75

Total Employer Individual Uninsured

$5,000 or more

$1,000-$4,999

23 21*

37 38

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Figure 7. Percent of Older Adults Who Spend ≥5% and ≥10% of Annual Income on Out-of-Pocket Medical

Expenses and Premiums, by Income

*Difference across income is statistically significant at p ≤ 0.05 or better.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

39

28

18

34 35

17

6

5055

43

0

25

50

75

Total <$25,000 $25,000-

$39,999

$40,000-

$59,999

$60,000+

5% or more of income 10% or more of income

*

*

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Figure 8. Percent of Older Adults Who Have At Least One of Four Cost-Related Access Problems,** by

Insurance Status and Income

*Difference across insurance coverage/income is statistically significant at p ≤ 0.05 or better.

**Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; did not see doctor when sick.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

33 31

11

54

30

1923

43

0

25

50

75

Total Employer Individual Uninsured <$25,000 $25,000-

$39,000

$40,000-

$59,999

$60,000+

Insurance Status Annual Income

*

*

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Figure 9. Percent of Older Adults with Medical Bill Problems** or Accrued Medical Debt, by Insurance

Status and Income

*Difference across insurance coverage/income is statistically significant at p ≤ 0.05 or better.

**Problems paying/not able to pay medical bills, contacted by a collection agency for medical bills, had to change way of life to pay bills, or has medical debt being paid off over time.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

4742

23

56

45

3135

53

0

25

50

75

Total Employer Individual Uninsured <$25,000 $25,000-

$39,000

$40,000-

$59,999

$60,000+

Insurance Status Annual Income

*

*

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Figure 10. Percent of Older Adults Who Are Worried That Health Insurance Will Become So Expensive That

They Will Not Be Able to Afford It

*Difference between uninsured and employer coverage is statistically significant at p ≤ 0.05 or better; Difference across income is statistically significant at p ≤ 0.05 or better.

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

5542

30

33

24 2937

39

57483841

57

2427

36

0

25

50

75

100

Total Employer Individual Uninsured <$25,000 $25,000-

$39,000

$40,000-

$59,999

$60,000+

Somewhat worried

Very worried

74 74 7581* 81* 84

7969

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

Insurance StatusAnnual Income

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75697171 73

0

25

50

75

100

Total <$25,000 $25,000-

$39,999

$40,000-

$59,999

$60,000+

Figure 11. Interest in Medicare Health Accounts* Among Older Adults in Working Families

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

*Respondents were asked: “Thinking about paying for your healthcare in the future, would you be interested in having 1% of your (and/or your spouse’s) earnings deducted from your paycheck(s), tax-free, and placed in your own Medicare account(s) to use for long-term care or other expenses not covered by Medicare?”

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

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4940

30

32

21

3233

36

7155

3540

67

25

26

35

0

25

50

75

100

Total Employer Individual Uninsured <$25,000 $25,000-

$39,999

$40,000-

$59,999

$60,000+

Somewhat interestedVery interested

70

81

9688

8173

6672

Figure 12. Percent of Older Adults Who Are Very/Somewhat Interested in Receiving Medicare Before Age 65, by Insurance Status and Income

Percent of adults 50-64 not on Medicare who are employed or whose spouse is employed

Note: Income groups based on 2003 household income.

Source: The Commonwealth Fund Survey of Older Adults (2004).

Insurance Status Annual Income

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Discussion• Older adults are becoming less protected from health care

costs: 50-64 uninsured climbed from 5.5 m. in 2000 to 6.6 m. in 2004

• 1.8 million insured older adults in working households are underinsured

• Concerns about effect of high deductible plans and HSAs on access to care and savings in this age group

• With high rates of chronic conditions, poorly covered older adults at risk of spending large shares of income on out-of-pocket costs, suffering adverse health events from skipping needed care, and accumulating medical debt

• Poor health can hinder older adults’ ability to work and save for retirement

• J.M. McWilliams, et al. found uninsured adults 55- 64 have reduced access to preventive care; more than 13,000 premature deaths occur annually in this age group because of a lack of health insurance coverage

• If older adults postpone/avoid care for chronic health problems, at risk of entering the Medicare program in deteriorating health and with costly medical conditions

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Policy Implications

• Survey shows strong interest among older adults in setting up Medicare accounts to set aside income for long-term and other health care expenses not covered by Medicare

• Strong interest in participating in the Medicare program before age 65

• Eliminating the two-year waiting period for the disabled in Medicare would alleviate the financial hardship of those under age 65 too ill or disabled to work

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Acknowledgements

Sara R. Collins, Karen Davis, Cathy Schoen, Michelle M. Doty, Jennifer L. Kriss, New Evidence on Health Coverage for Aging Boomers: Findings from The Commonwealth Fund Survey of Older Adults, Paper presented at NASI Annual Conference, January 20, 2006.

Visit the Fund at: www.cmwf.org

Michelle Doty,Senior Analyst

Commonwealth Fund

Cathy Schoen,Senior Vice PresidentCommonwealth Fund

Jennifer KrissProgram Assistant

The Commonwealth Fund

Karen Davis,President

Commonwealth Fund