Avoided Care Due to Cost - Age 65+ in West Virginia

West Virginia

The high cost of health care in the United States causes many older adults to forgo necessary medical care. A recent survey found that approximately 12% of individuals age 65 and older — about 6.5 million Americans — reported that they or a family member avoided essential medical services in the past year due to cost. Lack of health care access has long been associated with increased preventable hospitalizations, which can lead to worse and more expensive health outcomes. 

As people age, health care expenses tend to rise. Although older adults are less likely to have difficulty paying medical bills than younger adults (due in part to Medicare coverage), out-of-pocket health care expenses are nearly twice as high among adults age 65 and older compared with those ages 45-54. 

Additionally, Medicare does not generally cover dental, vision and hearing services that adults may require more frequently as they age.

According to America’s Health Rankings analysis, the prevalence of avoiding care due to cost is higher among:

• Hispanic, Asian and Black older adults compared with white older adults. 
• Older adults with less than a high school education compared with those with higher levels of education; college graduates have the lowest prevalence.
• Older adults with an annual household income less than $25,000 compared with those with higher levels of income. 
• Older adults who have difficulty with self-care compared with older adults without a disability.
• LGBQ+ older adults compared with straight older adults.
• Older adults who have not served in the U.S. armed forces compared with those who have served. 

A study of adults age 50 and older found that individuals with low health literacy reported delaying or forgoing needed medical care due to cost more often than those with adequate health literacy.

Interventions that reduce out-of-pocket costs and prevent disease may impact the proportion of older adults who avoid care due to cost — for example, offering dental coverage through Medicare.

Policies that improve the coordination of benefits and care between Medicare and Medicaid services should be implemented to better address the needs of low-income adults. With more funding and support from the Centers for Medicare & Medicaid Services and state Medicaid agencies, older adults can benefit from additional guidance as they transition to different coverage options at age 65. Many eligible older adults don’t enroll in the programs they qualify for, such as dual Medicare-Medicaid coverage, cost-sharing assistance programs or prescription drug cost-sharing assistance — emphasizing the need for assistance understanding their benefits and eligibility during this critical transition period. 

The Program of All-Inclusive Care for the Elderly (PACE) integrates health care and social services for eligible seniors, offering an alternative to nursing homes or other care facilities. PACE allows voluntary enrollment for individuals who meet the criteria, providing comprehensive benefits that cover all Medicare and Medicaid services along with other services recommended by health professionals.

Because a lack of health literacy is associated with avoiding care due to cost, efforts to improve health information and services for older adults could also have a positive impact. The Office of Disease Prevention and Health Promotion and the Health Resources and Services Administration offer tools and resources to improve health literacy.

Healthy People 2030 has an objective to reduce the proportion of people who cannot get medical care when needed.

Cha, Amy E., and Robin A. Cohen. “Problems Paying Medical Bills, 2018.” NCHS Data Brief No. 357. Hyattsville, MD: National Center for Health Statistics, February 2020. https://www.cdc.gov/nchs/data/databriefs/db357-h.pdf.

Levy, Helen, and Alex Janke. “Health Literacy and Access to Care.” Journal of Health Communication 21, no. sup1 (March 28, 2016): 43–50. https://doi.org/10.1080/10810730.2015.1131776.

Oakes, Diane, and Michael Monopoli. “Medicare Dental Benefit Will Improve Health And Reduce Health Care Costs.” Health Affairs Forefront, February 28, 2019. https://doi.org/10.1377/forefront.20190227.354079.

Rosano, Aldo, Christian Abo Loha, Roberto Falvo, Jouke van der Zee, Walter Ricciardi, Gabriella Guasticchi, and Antonio Giulio de Belvis. “The Relationship between Avoidable Hospitalization and Accessibility to Primary Care: A Systematic Review.” European Journal of Public Health 23, no. 3 (May 29, 2012): 356–60. https://doi.org/10.1093/eurpub/cks053.

Tipirneni, Renuka, and John Z. Ayanian. “Spillover Benefits of Medicaid Expansion for Older Adults With Low Incomes.” JAMA Health Forum 3, no. 6 (June 3, 2022): e221389. https://doi.org/10.1001/jamahealthforum.2022.1389.