Older Americans Forced to Choose Between Health and Wealth

Choosing Between Health and Wealth: The Financial Struggles of Older Adults

April 3, 2023

Older adults and their families face many financial issues in acquiring treatments and resources to support a sustained healthy lifestyle. Financial resources can be quickly drained by having to pay out-of-pocket for medication, supplemental coverage, or for long-term care.

These financial issues are a significant factor that drives healthcare choices for older American adults. Now consider this, older adults visit physicians more often than younger adults do, averaging 15 physician visits per year for adults aged 85 and older compared to 7.2 visits for adults aged 45 to 64. Overtime this financial impact may place an expected burden on the adults and their families. The dilemma – spend less on food and heat so they can afford their medication.

Here are some financial issues that seniors often consider when making healthcare decisions:

Medicare coverage: Most seniors are eligible for Medicare, a federal health insurance program that covers many healthcare services. However, seniors often have to pay out of pocket for some services and medications not covered by Medicare, which can influence their healthcare choices.

According to a study conducted by the Kaiser Family Foundation, in 2019, Medicare beneficiaries paid an average of $5,460 in out-of-pocket costs, including premiums, deductibles, and cost-sharing for services that Medicare does not cover. Some examples of health services that are not covered by Medicare and require out-of-pocket payments include: prescription drugs not covered by Part D, routine dental, vision, or hearing services, some long-term care services and alternative therapies such as acupuncture or massage therapy.

Over 30% of the nations drug spending is from Medicare Part D. (Single Care)

Fixed income: Many seniors are on a fixed income and have limited financial resources. They may need to prioritize healthcare services based on their budget and make difficult decisions regarding which healthcare services they can afford.

Health insurance coverage: Some seniors may have additional health insurance coverage through private insurance or Medicaid, which can influence their healthcare choices. Private insurance or Medicaid coverage can expand seniors’ access to healthcare services beyond what Medicare covers. For example, private insurance may cover certain prescription drugs, cover out-of-network providers, or alternative therapies that Medicare does not cover, while Medicaid may cover a greater selection of long-term care services.

Prescription drug costs: Prescription drug costs can be a significant financial burden for seniors, especially those with chronic health conditions that require long-term medication. If people cannot afford multiple prescriptions, they may choose not to fill all of their medications, skip doses, or split pills to make them last longer. This can lead to non-adherence to medication, which can cause other serious health consequences.

Not taking medications as prescribed can lead to compromised health outcomes. For example, if a senior with diabetes cannot afford their insulin, their blood sugar levels may become uncontrolled, leading to complications such as nerve damage, kidney disease, and blindness. The domino effect of this financial burden is a reduction in their quality of life, such as increased pain or discomfort, reduced mobility, and decreased ability to perform daily activities. Then, they may experience worsening health conditions that require hospitalization. The increased risk hospitalization can be costly and can further impact seniors’ financial resources.

Long-term care costs: Seniors may also need long-term care services, such as nursing homes or home healthcare, which can be costly. The cost of long-term care can influence their healthcare decisions and force them to make difficult choices about their living arrangements.

In summary, financial issues are a significant driver of healthcare choices for older American adults, including Medicare coverage, fixed income, health insurance coverage, prescription drug costs, and long-term care costs. Seniors often have to balance their healthcare needs with their financial resources and make difficult decisions based on their budget.


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