Adults in the United States who are approaching the Medicare eligibility age of 65 years face important decisions about healthcare and retirement. Recently, implementation of the Affordable Care Act (ACA) and the availability of Marketplace plans have complicated these decisions. Research on the health insurance decisions made by adults aged 50 to 64 years is detailed in a study published in JAMA.

Researchers used data from 1028 recipients aged 50 to 64 years who were administered the University of Michigan National Poll on Healthy Aging. Results were analyzed to determine concerns about health insurance and retirement. Measures assessed by the survey included healthcare avoidance based on cost, employment decision-making based on insurance considerations, and ability to afford health insurance within the next year and at retirement. Of the study cohort, 51.8% were female, 40.4% had a high school level education or less, and 65.2% were employed. More than half of the respondents had health insurance through an employer-sponsored plan. About one-fourth reported low confidence in their ability to afford insurance over the next year, and about half reported low confidence for their ability to afford insurance at retirement. A total of 18.8% of respondents stated that they kept a job or delaying retirement for the sake of keeping their insurance. A total of 18.2% of respondents stated that they avoided medical care or filling a prescription in the past year due to cost concerns. And more than half were concerned about potential changes to their health insurance based on future federal policies, especially those affecting people who are still working.

Researchers state that these findings are somewhat concerning, especially as they pertain to respondents avoiding medical care. As they note, those older than 50 are more likely to be diagnosed with chronic diseases and be in overall poor health, as 16.7% of respondents indicated. Additionally, those aged 50 to 64 who are of lower socioeconomic status have increased mortality. The researchers state that these affordability issues could lead to long-term health problems for adults in this age group and could have an effect on their ability to retire. The researchers point out that their findings track with national data on US workers’ retirement planning, which showed that 41% of US workers had low confidence in their ability to afford medical care in retirement.

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Overall, these findings highlight the need to help those nearing age 65 navigate health insurance options during the transition from working to retirement. The researchers contend that policies to increase affordability and availability of health insurance for those over 50, such as several proposals being considered by Congress, are needed to ameliorate this problem.

The study had several limitations including potential response bias, a lack of generalizability, context of national policy changes at the time of the study, and the inability to determine causality in terms of care affordability and avoidance. Despite this, the researchers argue that their methods aimed to mitigate these concerns where possible.


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