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High Insurance Costs Dissuade US Adults From Seeking Medical Care

February 14, 2020

As the number of US adults reaching retirement age continues to grow, researchers of a recent JAMA Network Open study sought to measure the association between high health insurance costs and potential avoidance of medical care, and found a significant percentage of those surveyed have concerns.

The researchers explained that as US adults approach Medicare eligibility, they face increasingly complex decisions regarding their insurance and health care including in which coverage to enroll, how to manage chronic conditions, and even when to retire based on financial decisions.

A cross-sectional online survey of 1028 community-dwelling adults, ranging from 50-years to 64-years old, was conducted from November 2018 to March 2019 with Ipsos KnowlegePanel, a nationally representative internet survey panel.

Survey results showed that more than one quarter (27.4%) of respondents have little to no confidence in being able to afford health insurance over the next year and nearly one-half (44%) reported little to no confidence in their ability to afford insurance in retirement.

In the past year, 13.2% of respondents did not get medical care and 11.9% avoided filling a prescription medication because of cost.

After adjusting for demographic and health characteristics, individuals with low confidence in health insurance affordability during either the next year or retirement were significantly more likely than those with higher confidence to avoid medical care (adjusted odds ratio, 2.89; 95% CI, 1.86-4.49; P < .001) and to avoid filling a prescription medication (adjusted odds ratio, 2.87; 95% CI, 1.71-4.80; P < .001) because of cost concerns.

“The formation of Marketplace plans and expansions of Medicaid coverage by the Affordable Care Act (ACA) have created a greater number of potential insurance options for adults aged 50 to 64 years, further complicating decisions about health insurance near and during retirement,” explained Renuka Tipirneni, MD, MSc, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, and colleagues.

The researchers continued “In addition, because health insurance may be associated not only with health but also with capacity to work, such health insurance concerns may be associated with whether adults aged 50 to 64 years feel flexibility to change jobs or retire, both directly and indirectly.”

The survey results also showed that despite the ACA’s expansion, designed to alleviate concern regarding leaving an employer for the sake of maintaining employer-sponsored insurance, more than 10% of adults reported delaying or considered delaying retirement.

“Given the variability in the timing of retirement, concerns about health insurance affordability near retirement likely have less to do with concerns about Medicare and more to do with costs of current plans or transitions between plans,” concluded the researchers. “Increasing out-of-pocket costs in recent years may be negatively associated with people’s perceptions of their ability to afford insurance now and in the future.”

The researchers suggest that new policy solutions are needed to help patients better understand coverage options, and improve their ability to navigate their years approaching Medicare eligibility.

—Edan Stanley


Tipirneni R, Solway E, Malani P, et al. Health insurance affordability concerns and health care avoidance among us adults approaching retirement [published online February 7, 2020]. JAMA Netw Open. 2020;3(2):e1920647. doi:10.1001/jamanetworkopen.2019.20647


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