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Commonwealth Fund Analyzes Affordability of Health Care for Older Americans with Employer Coverage

On August 10, 2023, the Commonwealth Fund released its issue brief, Can Older Adults with Employer Coverage Afford Their Health Care?  The Commonwealth Fund examined whether employer health coverage is providing adequate protection for health care costs for older adults ages 50 to 64. Overall, this age group is considered to be at a higher risk of health care expenditures. The brief is based on findings from the Commonwealth Fund Biennial Health Insurance Survey, 2022. 

The brief used data from the survey to analyze whether older adults ages 50 to 64 with employer health care coverage find their health plans and their health care to be affordable. In particular, the study focused primarily on the experience of older adults with low and moderate income.

Low income is defined as less than 200% of the federal poverty level (or $27,180 for an individual and $55,500 for a family of four in 2022). Moderate income is defined as 200% of slightly under 400% of the federal poverty level (or $54,360 for an individual or $111,000 for a family of four in 2022).

The key findings include:

  • About 50% of low-income older adults and more than 33% of those with moderate income indicated that it was very or somewhat financially challenging to afford their premiums;
  • 54% of low-income adults and about 33% of moderate-income adults were underinsured and facing high out-of-pocket costs and/or deductibles compared to their income;
  • About 50% of low-income adults reported delaying or eliminating needed health care due to cost;
  • Of the older adults that had difficulties paying medical bills and paying off medical debt, about 44% were low-income adults and 40% were those with moderate income; and
  • About 63% of those older adults that are facing medical bills and debt were not confident that they had sufficient assets to retire.

The brief indicated that, “One of the most important functions of health insurance is to protect people against catastrophic health care costs. Older adults also depend on good health insurance to enable access to care without the fear of incurring medical debt. The survey data in this brief indicate employer health insurance is failing many older adults especially those with low and moderate incomes.”

The brief is available here.