Rising Health Care Costs Push Some Middle-Aged Adults to Skip the Document Until Medicare
John Galvin knows he needs a colonoscopy. But she’s waiting to schedule the procedure until December, when she turns 65 and becomes eligible for Medicare.
He was already thinking about delaying it — and his monthly Obamacare insurance premium tripled this year to $2,460, about a third of his salary, he said. And with a $2,700 deductible, he’ll be on the road for most of the diagnostic tests, a financial burden he says he can’t avoid.
“It would have cost about $3,000,” said Galvin, who lives in North Kingstown, Rhode Island, and recently retired as director of a long-term medical device company. “I quit.”
Galvin said his wife, Nancy, is putting off an expensive CT scan for a few years until she also qualifies for Medicare, so she can pay the bills. The federal health plan provides coverage to all Americans age 65 and older.
People on the Affordable Care Act plans nearing retirement age received the largest price increase following the expiration of enhanced federal subsidies at the end of December. Those with incomes above 400% of the federal poverty level — $86,560 for a family of two — have been getting help paying for programs since the Biden administration increased funding during the covid-19 crisis. Adults ages 50 to 64 make up nearly half of ACA enrollees.
Now, without that federal financial assistance, some in this age group say they struggle to delay care until they qualify for Medicare.
Delaying Care May Increase Health Costs and Risks
Not only does that put their physical health at risk, say patient advocates, doctors, and health policy researchers, but it could change costs — and could lead to taxpayers footing even bigger bills to fix health problems that worsen during the delay.
“There’s going to be a lot of unmet need and unmet need,” said Jessica Schubel, a health policy adviser who served in the Obama and Biden administrations. “Medicare is going to have to spend a lot of money covering and covering their treatment.”
The Affordable Care Act became the primary source of health care for people ages 50 to 64. Access to Obamacare programs has helped cut the uninsured rate of this age group in half, according to AARP, an advocacy group that represents seniors. That allows some people to retire early while maintaining coverage.
It also provides a safety net for small business owners and those whose jobs do not offer health insurance. Last fall, the longest government shutdown ever occurred amid a failed effort by Democrats to extend enhanced funding. Republicans opposed to the expansion said the bailout went to insurers, encouraging fraud and money laundering.
The issue will continue to have political relevance, especially in the midterm elections, including with older Americans who appear to be loyal to the polls, said Republican strategist Gregg Keller, who runs the Atlas Strategy Group.
“Is affordability going to be a problem? Absolutely,” he said. “Will health care costs contribute to that? Yes.”
Even before the funding expired, the cost of medical care, nursing homes, and prescription drugs were among the top health-related concerns for people over 50, a 2024 University of Michigan survey found. Middle-aged adults with Obamacare plans are feeling pressured by outdated funding, because the ACA allows insurers to charge 60-year-olds up to three times the premiums of 20-year-olds, who tend to use fewer medical services.
And many middle-aged adults are already enrolled in the cheapest plans available, leaving them with no cheap options to fall back on, said Matt McGough, a policy analyst for KFF, the nonprofit health information organization that includes KFF Health News.
“This is very bad for the elderly who are registered in the markets,” he said.
Someone making a few dollars more than 400% of the federal poverty level earns too much to qualify for subsidies now, and in some states average payments were due to at least triple for this group.
Many people see annual rate increases of thousands of dollars, with premium payments amounting to nearly a quarter of their income. John Ayanian, a primary care physician and health policy researcher at the University of Michigan, said he has regular conversations with elderly patients trying to figure out how to get medical care. Some in their early 60s may drop ACA coverage because of higher premiums, she said.
“That’s a gamble,” he added.
Marci Heinbaugh might take that bet. The 63-year-old social worker, who lives in rural Illinois, said her monthly payments more than doubled, from about $1,100 to $2,333, for a plan with a $10,150 out-of-pocket cost.
He knew he would be paying more, he said, but he didn’t expect the increase. A few months later, he is not sure if he will stick with the program until the end of the year. He said he might travel without insurance.
“I’m worried even thinking about that,” Heinbaugh said.
‘Impossible Choices’
People want to buy their insurance in the marketplace, and many middle-aged adults can afford it with little government financial assistance, said Alan Weil, senior vice president of public policy at AARP. Those who drop coverage or delay care until age 65 may save money now, but that could cost them — and taxpayers — more later.
“It is possible that the so-called savings associated with reducing subsidies as people retire will end up turning into higher costs of using Medicare,” Weil said.
And Medicare enrollees are not immune from rising costs. In January, for example, average Medicare Part B premiums rose from $185 a month to about $203.
Until Galvin joins Medicare, she said, she expects to use a $30,000 retirement account to pay for her marketplace plan premiums and deductibles.
A 2024 AARP survey found that 1 in 5 adults over age 50 did not have enough money for retirement and 3 in 5 were worried they would not have enough money to support themselves in retirement.
The expiration of these Obamacare subsidies is putting more financial pressure on Americans as they approach retirement, health policy researchers say.
“It forces people to make impossible decisions,” said Natalie Kean, director of health rights advocacy for the national nonprofit Justice in Aging.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the active programs at KFF – an independent source for health policy research, polling, and journalism.
This article first appeared in USA TODAY: Rising health care costs push middle-aged adults to skip doctor to Medicare
Reported by Sam Whitehead, KFF Health News / USA TODAY
USA TODAY Network via Reuters Connect
