Health Insurance Coverage of People Aged 55 to 64: Implications for a Medicare Buy-In

Health Insurance Coverage of People Aged 55 to 64: Implications for a Medicare Buy-In

Health Insurance Coverage of People Aged 55
to 64: Implications for a Medicare Buy-In
Chris L. Peterson
Specialist in Health Care Financing
Mark Newsom
Analyst in Health Care Financing
January 14, 2010
Congressional Research Service
7-5700
www.crs.gov
RL34596
CRS Report for Congress
P
repared for Members and Committees of Congress

Health Insurance Coverage of People Aged 55 to 64

Summary
Approximately 4.3 million adults between the ages of 55 and 64 were estimated to be without
health insurance in 2008, according to the U.S. Census Bureau’s Current Population Survey
(CPS). This amounts to approximately one out of eight (12.5%) of these adults, often called the
“near elderly.”
The near elderly have the lowest uninsured rate among adults aged 19 to 64. This may be driven,
at least in part, by where this group is in their life cycle. At this point in their lives, many of the
near elderly may be in their peak earning years and be able to access employer-sponsored
coverage. At the same time, however, many may be facing important and personally
unprecedented health and work decisions, some of which could undermine their access to
employer-sponsored coverage. These decisions may be affected by some new challenges this age
group faces at this point in their lives: (1) a greater prevalence of chronic conditions; (2) a greater
likelihood of certain acute conditions, such as a heart attack and stroke; and (3) more assets to
protect from catastrophic health care costs. This report shows that the near elderly are
significantly more likely than other nonaged adults to be in fair or poor health, and to have had a
heart attack or stroke. More than two-thirds of the near elderly (68.0%) have one of six chronic
conditions, a significantly higher percentage than even the next highest age group, 45- to 54-year-
olds (51.2%). The near elderly are also more likely to have assets, compared with all other
nonaged adult age groups.
Average per capita health care spending among the near elderly in 2004 ($7,787) was 50% more
than among 45- to 54-year-olds ($5,210) and more than double that of 19- to 44-year-olds
($3,370). These spending levels carry over into their health insurance costs. In the nongroup
market in 2009, the near elderly faced deductibles averaging $3,022 and annual premiums
averaging $5,349. This average premium level exceeded those faced by 45- to 54-year-olds by
more than $1,500, and was nearly triple the premiums for 25- to 34-year-olds. The near elderly
were more likely than their younger adult counterparts to spend more than 10% of their after-tax
income on health care and health insurance premiums. In fact, for those with private nongroup
coverage, 69% of the near elderly were in families that spent more than 10% of their after-tax
income on health care and health insurance premiums.
Compared with uninsured 25- to 54-year-olds, the 4.3 million near elderly uninsured are more
likely to be female or native-born. This is true even after accounting for underlying population
differences between the near elderly and 25- to 54-year-olds. The near elderly uninsured are also
more likely to have a household income below $25,000 and to be in poor or fair health.
Uninsurance can have more severe consequences for the near elderly, considering their increased
needs for health care and asset protection. Yet, even the near elderly who have health insurance
face much greater financial burdens from these costs than younger adults.
Extending Medicare eligibility has been one legislative proposal to protect this population from
being uninsured or subject to the high costs of the individual insurance market. To keep costs
down for the government, it has been proposed that the expansion involve buying into Medicare
by paying premiums that cover the actuarial cost of the program. Depending on the specifics of
the program, a Medicare Buy-In could raise several potential issues, including adverse selection,
high costs to the beneficiary or to the government, additional financial pressures on health care
providers and health insurance companies, and incentives for retiring early.
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Health Insurance Coverage of People Aged 55 to 64

Contents
Sources of Health Insurance of the Near Elderly.......................................................................... 1
Changes over time in coverage of the near elderly ........................................................... 3
Characteristics of the Uninsured Near Elderly ............................................................................. 4
Characteristics of the uninsured near elderly, compared with uninsured
aged 25 to 54 ............................................................................................................... 4
Characteristics of the uninsured near elderly, compared with insured near elderly............ 4
Effect of being uninsured and near elderly, beyond the underlying population
differences between the near elderly and 25- to 54-year-olds ....................................... 5
Health, Health Care Spending, and Health Insurance for the Near Elderly ................................... 7
Medicare Buy-In ....................................................................................................................... 13
Legislative Activity in the 111th Congress ...................................................................... 14
Issues for Consideration ................................................................................................ 15

Figures
Figure 1. Sources of Health Insurance, by Age, Among 25- to 64-Year-Olds, 2008 ...................... 2
Figure 2. Percentage of Firms That Offer Health Insurance to Retirees Under Age 65
(pre-Medicare), by Firm Size ................................................................................................... 3
Figure 3. Personal Health Care Spending Per Capita, by Age, 2004 ............................................. 9
Figure 4. Nongroup Premiums and Deductibles, by Age, 2009 .................................................. 11
Figure 5. Percentage of Medically Underwritten Applicants for Nongroup Coverage Who
Were Denied, 2008................................................................................................................. 11
Figure 6. Financial Burden of Health Care and Health Insurance, by
Insurance and Age, 2005 ........................................................................................................ 12

Tables
Table 1. Characteristics of the Insured and Uninsured, by Age, Among 25- to 64-Year-
Olds, 2008 ............................................................................................................................... 6
Table 2. Health Status and Disease Incidence, by Age, 2007-2008 ............................................... 8
Table 3. Percentage of Nonelderly Adults Who Live in a Household with Assets and, If
So, Median Amount of Those Assets, by Insurance Status and Age, 2005 ................................. 9
Table A-1. Percentage of Adults in Families with Out-of-Pocket Spending on Health Care
and Health Insurance Premiums Exceeding 10% of After-Tax Income, by Insurance and
Age, 2005 .............................................................................................................................. 18

Appendixes
Appendix. Technical Data ......................................................................................................... 17
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Health Insurance Coverage of People Aged 55 to 64

Contacts
Author Contact Information ...................................................................................................... 20

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Health Insurance Coverage of People Aged 55 to 64

pproximately 4.3 million adults between the ages of 55 and 64 were estimated to be
without health insurance in 2008, according to the U.S. Census Bureau’s Current
A Population Survey (CPS). This amounts to approximately one out of eight (12.5%) of
these “near elderly” adults. Excluding the elderly, nearly all of whom are enrolled in Medicare,
the near elderly have the lowest percentage of uninsurance of any adult age group. Yet,
uninsurance can have more severe consequences for the near elderly, considering their increased
needs for health care and asset protection. Some have suggested that the best method to protect
this potentially vulnerable population is to allow them to buy into Medicare eligibility.1 To
explore these and other issues, this report describes the health insurance, health, and health care
spending of the near elderly, particularly as compared with other nonelderly (under age 65)
adults. The report also briefly describes Medicare expansion proposals for the near elderly. Unless
specified otherwise, all comparisons in this report are among nonelderly adults aged 25 to 64.2
Sources of Health Insurance of the Near Elderly
Approximately two-thirds of the near elderly (68%) have job-based coverage, a similar rate as the
entire adult population between 25 and 64 years of age. However, the near elderly are much more
likely to have non-work-related private coverage (10%), as shown in Figure 1. For those under
age 65, Medicare eligibility is mostly restricted to the disabled who have received cash disability
payments for at least two years.3 The rate of Medicare enrollment among the near elderly (10%)
is more than double the next highest age group (4% among 45- to 54-year-olds). The near elderly
also have much higher rates of military/veterans coverage. However, the percentage of near
elderly covered through Medicaid, the Children’s Health Insurance Program (CHIP), or other
means-tested public health insurance programs is the same as the nonelderly adult population
overall.

1 For example see “Rockefeller fights for Medicare Early Access Act,” December 8, 2009. Available at
http://rockefeller.senate.gov/press/record.cfm?id=320555 and “Rep. Weiner: Medicare at 65, Why Not 55, 45, 35?,”
December 7, 2009. Available at http://weiner.house.gov/news_display.aspx?id=1379.
2 Twenty-five years of age was generally used as the minimum for adults in this analysis, primarily because adults aged
19 to 24 are so dissimilar to other adults, especially the near elderly, with respect to their health, health insurance, and
health care spending that their inclusion would not be useful.
3 Those with end-stage renal disease (ESRD) are also eligible for Medicare. Coverage for these individuals generally
begins in the fourth month of dialysis treatments or the month of a kidney transplant. Persons under age 65 who receive
cash disability benefits from Social Security or the Railroad Retirement systems for at least 24 months are also entitled
to Medicare. (Because there is a five-month waiting period for cash payments, the Medicare waiting period is
effectively 29 months.) The 24-month waiting period is waived for persons with amyotrophic lateral sclerosis (ALS,
“Lou Gehrig’s disease”). For more information, see CRS Report R40425, Medicare Primer.
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Health Insurance Coverage of People Aged 55 to 64

Figure 1. Sources of Health Insurance, by Age, Among 25- to 64-Year-Olds, 2008
75%
72%
70%
69%
68%
65%
61%
60%
30%
27%
Age 25-34
25%
Age 35-44
Age 45-54
19%
20%
Age 55-64
16%
15%
13%
10%
10% 9%
10%
8% 7%
7%
8%
5% 6%
6%
4%
5%
2%
3%
3%
1%
3%
0%
Job-based
Private
Medicare
Medicaid
Military/veterans
Uninsured
Non-work

Source: CRS analysis of data from the March 2009 Current Population Survey (CPS).
Notes: Job-based coverage includes coverage from a spouse. Near elderly men have significantly higher rates of
job-based and military/veterans coverage than near elderly women, while near elderly women have significantly
higher rates of private non-work and Medicaid coverage. Combined, there is no statistically significant difference
between the uninsurance rates of near elderly men and women. The percentages by age sum to more than 100%
because people may have more than one source of coverage during the year.
Figure 2 shows the percentage of large firms (500 or more employees) offering health insurance
that also offer retiree coverage to individuals before they become eligible for Medicare (that is,
before they turn 65). In 1993, the percentage was 46%, dropping to 28% in 2003, but rising to
31% in 2007. The increase between 2005 and 2007 was a “[s]urprise uptick” driven by firms with
500 to 999 employees. In the other large firm-size groups (1,000+ employees), offer rates for pre-
65 retiree coverage were unchanged between 2005 and 2007, or were significantly lower.
According to Beth Umland of Mercer, “Employers in this [500-999] group may have decided to
add retiree coverage in order to better compete for labor with larger employers, where retiree
coverage is more common. They would have made the decision to add coverage for 2007 back in
2006 or 2005, when the economy was in better shape.” Recent similar trends are also shown for
small employers (10-499 workers), although with much lower pre-65 retiree-health offer rates.4

4 Blaine Bos and Beth Umland, “Mercer’s National Survey of Employer-Sponsored Health Plans 2007,” p. 44. Also,
personal correspondence with Beth Umland, July 2008.
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Health Insurance Coverage of People Aged 55 to 64

Figure 2. Percentage of Firms That Offer Health Insurance to Retirees Under Age 65
(pre-Medicare), by Firm Size
50%
500+ workers
46%
10-499 workers
41%
40%
35%
38%
31%
30%
29%
29%
28%
20%
12%
13%
10%
8%
7%
7%
5%
5%
0%
1993
1995
1997
1999
2001
2003
2005
2007

Source: Blaine Bos and Beth Umland, “Mercer’s National Survey of Employer-Sponsored Health Plans 2007,” p.
44. Also, personal correspondence with Beth Umland, July 2008.
Note: 1997 data not available for smal er firms.
Changes over time in coverage of the near elderly
Despite declining rates over the past decade of employers offering pre-65 retiree coverage or
health insurance generally, the near elderly were able to maintain similar levels of private and
public coverage between 1996 and 2007, according to estimates from the Medical Expenditure
Panel Survey (MEPS).5 There were significant declines between 1996 and 2007 in the percentage
covered by private coverage for 25- to 34-year-olds, 35- to 45-year-olds, and 45- to 54-year-olds;
however, private coverage rates were not significantly different for the near elderly in 2007 than
in 1996. In addition, there were significant increases between 1996 and 2007 in the uninsured
percentage among 25- to 34-year-olds, 35- to 45-year-olds, and 45- to 54-year-olds; however, the
uninsured rate for the near elderly was not significantly different in 2007 from what it was in
1996.
Declining pre-65 retiree offers may have been offset for the near elderly by other factors. For
example, the near elderly may now be more likely to seek employment in firms with pre-65
retiree coverage and/or to accept that coverage when offered. The near elderly are also more
likely to work than they were a decade ago,6 perhaps focused in firms that offer coverage.
Even going back 20 years, job-based coverage among the working near elderly has not changed
significantly. In 1987, 78% of near elderly workers had job-based coverage, which was the same

5 For changes over time, MEPS was used rather than the CPS, because the latter has undergone changes over the past
several years that tend to make the results not comparable. MEPS first provided data for 1996.
6 Table 2, CRS Report RL30629, Older Workers: Employment and Retirement Trends, by Patrick Purcell.
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Health Insurance Coverage of People Aged 55 to 64

percentage in 2006 and even higher (80%) in 2007. The statistically significant changes in health
insurance among near elderly workers between 1987 and 2007 appear to be the decline in private
non-work coverage (from 11% in 1987 to 5% in 2007) and the increase in the uninsured (from
9% in 1987 to 13% in 2007). But most of those changes occurred in the 1987-1996 period rather
than the 1996-2007 period.7
Characteristics of the Uninsured Near Elderly
Table 1 shows the characteristics of the 4.3 million uninsured near elderly, comparing those
characteristics to the insured near elderly, as well as to 25- to 54-year-olds, both insured and
uninsured.
Characteristics of the uninsured near elderly, compared with uninsured aged
25 to 54
As a group, compared with uninsured 25- to 54-year-olds, the uninsured near elderly are more
likely to be female, white, native-born, or to be in fair or poor health. The near elderly uninsured
are less likely than their younger uninsured counterparts to be working or to have worked full
time all year. The near elderly uninsured are also more likely to have annual household income8
below $25,000, compared with the uninsured between 25 and 54 years of age.
Characteristics of the uninsured near elderly, compared with insured near
elderly
Compared with the near elderly who are insured, the uninsured near elderly are less likely to be
white or native-born. The near elderly uninsured are also less likely to be working or to have
worked full time all year, compared with their insured peers. The near elderly uninsured are also
more likely than their insured peers to be in fair or poor health. They are also more likely to have
annual income below $25,000, compared with the insured near elderly. Approximately 54% of the
uninsured near elderly have annual family income below $25,000, compared with 19% of their
insured peers.9

7 CRS analysis of the 2007 MEPS and of estimates presented in Alan C. Monheit et al., “Moving To Medicare: Trends
In The Health Insurance Status Of Near-ElderlyWorkers, 1987—1996,” Health Affairs, vol. 20, no. 2, pp. 204-213
http://content.healthaffairs.org/cgi/reprint/20/2/204.pdf.
8 Household income refers to the income of everyone in the household, regardless of whether or not they are related.
9 “Family income” is based on only the income of the near elderly, their spouse, and dependent children in the home.
This definition is more precisely referred to as the income of “health insurance units” (HIU). This term distinguishes it
from how the CPS defines “family,” which treats everyone in the household who is related as a single family. Under
the HIU definition, more than 90% of the uninsured near elderly are adults living without dependent children. The HIU
definition of family income is often considered more useful for health-policy analyses, because it tends to mirror
eligibility for family coverage in the private market as well as the definition of family income for some means-tested
programs.
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Effect of being uninsured and near elderly, beyond the underlying population
differences between the near elderly and 25- to 54-year-olds 10
As previously discussed, Table 1 shows comparisons of the uninsured near elderly and uninsured
25- to 54-year-olds. Although it may not be surprising to find these two uninsured groups differ
significantly in many of their characteristics, how much of these differences are simply
attributable to the fact that the near elderly differ from younger adults generally? In other words,
are there certain characteristics that the uninsured near elderly have, beyond what one might
expect after taking into account the underlying population differences between the near elderly
and 25- to 54-year-old populations? The answer is sometimes yes, sometimes no.
Instances where the uninsured near elderly are significantly different from uninsured 25- to 54-
year-olds, even after accounting for differences in the underlying populations, are that the
uninsured near elderly are still more likely to be female and native-born citizens. After accounting
for differences in the underlying populations, the uninsured near elderly are still less likely than
their 25- to 54-year-old uninsured counterparts to be Hispanic.
However, certain other general population differences between the near elderly and younger
adults wash away differences between their uninsured populations. For example, the initial
comparison showed that the near elderly uninsured were more likely to be white or to not work,
compared with their younger uninsured counterparts. But after adjusting for the underlying
population differences between the two age groups, the proportion of near elderly uninsured who
were white or did not work was not significantly different than uninsured 25- to 54-year-olds. In
other words, the reason the uninsured near elderly were more likely to be white or not work,
compared with younger uninsured adults, was related to the characteristics of their respective age
groups rather than their insurance status.
Interestingly, adjusting for the underlying population differences actually reverses some of the
comparative results. For example, Table 1 shows the uninsured near elderly were significantly
less likely than uninsured 25- to 54-year-olds to have worked full time for the entire year—43.4%
compared with 53.7%, respectively. However, 25- to 54-year-olds work full time all year in much
larger proportion overall, compared with the near elderly. Adjusting for these population
differences reveals that the uninsured near elderly actually have a greater likelihood of working
full time all year, compared with uninsured 25- to 54-year-olds.

10 This portion of the report is based on a method referred to as difference-in-differences. For the sake of simplicity,
these results and the corresponding significance testing are not displayed in the tables.
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Health Insurance Coverage of People Aged 55 to 64

Table 1. Characteristics of the Insured and Uninsured, by Age,
Among 25- to 64-Year-Olds, 2008

Age 25-54
Age 55-64
Insured
Uninsured
Insured
Uninsured
Sex

Male
48.2%
55.6% *
48.0%
49.2%
Female
51.8%
44.4% *
52.0%
50.8%

100.0%
100.0%
100.0%
100.0%
Race/Ethnicity

White
69.8% *
45.4% *
78.2% *
59.0%

Black
11.4%
14.9% *
9.8% *
11.9%

Hispanic
11.8% *
32.5% *
7.0% *
20.3%
Other
7.0% *
7.2% *
5.0% *
8.9%

100.0%
100.0%
100.0%
100.0%
Citizenship
status

Native-born
86.0% *
67.3% *
89.7% *
74.4%

Naturalized
6.6% *
7.3% *
7.0% *
11.9%
Non-citizen
7.4% *
25.4% *
3.4% *
13.8%

100.0%
100.0%
100.0%
100.0%
Firm size

Did not work
8.3% *
16.4% *
24.2% *
30.6%
Less than 10 employees
10.7% *
31.1%
12.4% *
32.0%
10 - 99 employees
18.2%
24.4% *
14.4% *
16.7%
100+ employees
62.7% *
28.2% *
49.0% *
20.7%

100.0%
100.0%
100.0%
100.0%
Employment
status

Did not work
8.3% *
16.4% *
24.2% *
30.6%
Worked ful -time, ful -year
76.7% *
53.7% *
58.8% *
43.4%
Worked, not full-time, full year
15.0% *
30.0% *
17.0% *
26.1%

100.0%
100.0%
100.0%
100.0%
Reported
health
status

Excel ent or very good
67.0% *
52.5% *
50.5% *
36.2%

Good
23.2% *
34.1% *
29.3% *
38.0%
Fair or poor
9.8% *
13.4% *
20.2% *
25.9%

100.0%
100.0%
100.0%
100.0%
Household
income

Less than $25,000
10.0% *
29.3% *
14.2% *
36.9%
$25,000 to less than $50,000
18.5% *
33.2% *
20.1% *
28.4%
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Health Insurance Coverage of People Aged 55 to 64

Age 25-54
Age 55-64
Insured
Uninsured
Insured
Uninsured
$50,000 to less than $75,000
21.4% *
17.0% *
19.7% *
15.0%
$75,000 to less than $100,000
17.3% *
9.4% *
14.6% *
7.7%
$100,000 or more
32.8% *
11.1%
31.4% *
12.1%

100.0%
100.0%
100.0%
100.0%
Family
(HIU)
income

Less than $25,000
16.7% *
55.8%
19.2% *
54.2%
$25,000 to less than $50,000
22.2% *
28.3% *
21.8% *
24.9%
$50,000 to less than $75,000
20.4% *
9.0%
18.8% *
10.1%
$75,000 to less than $100,000
14.8% *
3.3%
13.6% *
4.1%
$100,000 or more
26.0% *
3.6% *
26.6% *
6.8%

100.0%
100.0%
100.0%
100.0%
Source: CRS analysis of data from the March 2009 Current Population Survey (CPS).
Notes: Asterisk indicates statistically significant differences (p<0.05) with the near elderly. Household income
includes everyone in a household, regardless of whether they are related. Family income, using “health insurance
units” (HIU), includes only the income of the individual, spouse, and dependent children.
Health, Health Care Spending, and Health
Insurance for the Near Elderly
Among the reasons people seek health insurance are the following: (1) to pay for and provide
access to health care in the case of an unexpected health event, (2) to pay for and provide access
to health care for expected and/or chronic health care needs, and (3) to protect one’s financial
assets from being drained by health care expenses. All three of these reasons are potentially more
important for the near elderly than other nonelderly age groups because of the near elderly’s
greater use of health care, higher health care spending, and greater assets.
Table 2, which shows characteristics of individuals regardless of their health insurance status,
demonstrates how self-reported health status worsens with age. The prevalence of most chronic
conditions increases with age (except for asthma, as shown in Table 2). The near elderly are also
significantly more likely to ever have had a stroke or heart attack, compared with younger
individuals.11
As a result, the near elderly had average health care spending of $7,787 in 2004. This is 50%
more than 45- to 54-year-olds’ per-capita spending ($5,210) and more than double the spending
for 19- to 44-year-olds ($3,370).12

11 CRS analysis of the 2005 Medical Expenditure Panel Survey (MEPS). When 2005 MEPS data are used in this report,
it is because the publicly available 2006 MEPS data do not yet include those particular variables.
12 “Total Personal Health Care Spending, by Age Group,” Centers for Medicare and Medicaid Services, Office of the
Actuary, National Health Statistics Group, available at http://www.cms.hhs.gov/NationalHealthExpendData/
(continued...)
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Table 3 shows, as expected, the near elderly are more likely to have assets and, when they have
them, to have more. This is true across all sources of health insurance. Table 3 also shows that the
near elderly who have private health insurance are significantly more likely to have assets than
those with public coverage or without coverage. In fact, this is true for all the age groups. It is
difficult to determine how much of the motivation to purchase private coverage was due to the
desire to protect assets versus the desire to ensure that necessary care would be received and paid
for.13 In every age group, those with public coverage were least likely to have assets—even less
than the uninsured. Most of the near elderly enrolled in Medicaid are subject to limitations on
their countable assets. Those in Medicare are mostly disabled and will not have worked for at
least two years, potentially depleting some of their assets before obtaining coverage.
The findings above, broken down by age, are consistent with the notion that the need and desire
for health insurance increases with age, resulting in relatively greater coverage—although often at
a much higher price, as discussed below.
Table 2. Health Status and Disease Incidence, by Age, 2007-2008
Health Status/
Disease Incidence
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Self-reported health status

Excel ent/ very good
71.2%
*
65.8%
*
55.9%
*
48.7%

Good
22.3%
* 24.8%
* 28.9%
* 30.4%
Fair/Poor
6.5% *
9.5% *
15.3% *
20.9%
Ever diagnosed with certain chronic condition(s)
Any of the six below
230.%
*
34.3%
*
51.2%
*
68.0%

High blood pressure
7.9%
*
15.7%
*
29.7%
*
46.7%

High
cholesterol
8.5%
* 18.0%
* 31.4%
* 44.9%

Diabetes
1.7%
* 3.7%
* 8.2%
* 15.9%

Asthma
9.8%
8.9%
8.7%
9.0%

Chronic
heart
conditions
0.3%
* 0.8%
* 3.4%
* 6.9%

Emphysema
0.1%
* 0.4%
* 1.3%
* 3.0%
Ever experienced certain acute conditions

Heart
attack
0.1%
* 0.4%
* 2.9%
* 4.9%

Stroke
0.3%
* 0.7%
* 2.1%
* 4.0%
Sources: CRS analysis of 2008 data from the March 2009 Current Population Survey (CPS) and the 2007
Medical Expenditure Panel Survey (MEPS).

(...continued)
downloads/2004-age-tables.pdf. Health care spending does not include payments for premiums, which finance this
spending.
13 See discussion and 2002 results from MEPS in Didem Bernard et al., “Wealth, Assets, and the Affordability of
Health Insurance,” Agency for Healthcare Research and Quality (AHRQ) working paper, June 18, 2007.
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Notes: An asterisk indicates estimates that are significantly different from those in the 55- to 64-year-old
category (p<0.05). Conditions are included in MEPS as “priority conditions.” “Chronic heart conditions” are
coronary heart disease and angina.
Figure 3. Personal Health Care Spending Per Capita,
by Age, 2004
$1,225
$4,147
$2,415
Total:
55-64
$7,787
$899
$2,860
$1,451
Total:
45-54
$5,210
$520
$1,749
$1,100
Out of pocket
Total:
Private ins. and other private
19-44
$3,370
Total public
$0
$1,000 $2,000 $3,000 $4,000 $5,000 $6,000
$7,000 $8,000 $9,000

Source: “Total Personal Health Care Spending, by Age Group,” Centers for Medicare and Medicaid Services,
Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/
downloads/2004-age-tables.pdf.
Table 3. Percentage of Nonelderly Adults Who Live in a Household with Assets and,
If So, Median Amount of Those Assets, by Insurance Status and Age, 2005
Insurance Status
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Percentage with savings or investments
All 78%
*
81%
*
84%
*
85%

Privately
insured
88%
* 89%
* 90%
91%

Public
coverage
49% 48% * 51%
54%

Uninsured
60%
* 58%
* 62%
* 70%
Median savings and investments among those with such amounts
All $4,000

$8,000

$13,000

$22,250

Privately
insured
$5,500
$11,000
$18,000
$30,800

Public
coverage
$640
$400
$500
$600

Uninsured
$1,400
$1,280
$2,000
$2,200
Percentage with positive wealth
All 89%
*
93%
*
94%
*
96%

Privately
insured
93%
* 96%
* 97%
* 98%

Public
coverage
75%
* 73%
* 75%
80%

Uninsured
84%
* 86%
* 87%
* 92%
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Insurance Status
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Median wealth among those with positive wealth
All $50,830

$117,630

$180,700

$222,200

Privately
insured
$69,280 $149,920 $220,900 $267,000

Public
coverage
$6,400 $12,180 $18,190 $20,990

Uninsured
$18,910 $38,220 $53,490 $81,470
Source: CRS analysis of Survey of Income and Program Participation (SIPP), with core data (sources of health
insurance, age) from September 2005 and assets data from Topical Module for wave 6.
Notes: “Savings and investments” consists of interest-earning assets held in banking and other institutions,
equity in stocks and mutual fund shares, equity in other assets, and equity in IRA and Keogh accounts. “Wealth”
includes these amounts as wel as home equity, net equity in vehicles, business equity, and equity in real estate
other than one’s own home. An asterisk indicates estimates that are significantly different from those in the 55-
to 64-year-old category (p<0.05). Significance testing was not performed on the median amounts.
Figure 4 shows average premiums and deductibles in the nongroup market in 2009.14 The
average deductible faced by the near elderly ($3,022) was 36% more than the other age groups’
lowest average deductible, $2,223 among 25- to 34-year-olds. But this difference paled in
comparison to the premium differences, where the near elderly ($5,349) paid nearly triple the
average premium of 25- to 34-year-olds ($1,860).15 The average annual premiums for the near
elderly in private nongroup coverage was $1,563 more than those for 45- to 54-year-olds,
although the deductible levels were similar (Figure 4). This is among those who actually obtain
nongroup coverage. Figure 5 shows that the near elderly are most likely to be denied nongroup
coverage based on medical underwriting.

14 Based on a survey of health insurers providing nongroup coverage by America’s Health Insurance Plans (AHIP).
15 In other words, the premium ratio between the near elderly and 25- to 34-year-olds was 2.88:1. If the deductible
levels were the same, the ratio would be higher—perhaps 3:1. Once the private market reforms are fully implemented,
H.R. 3962 would permit nongroup premiums to vary for age by no more than 2:1, while S.Amdt. 2786 to H.R. 3590
would permit premium variation by age of up to 3:1.
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Figure 4. Nongroup Premiums and Deductibles, by Age, 2009
$6,000
$5,349
$5,000
Deductible
Annual Premium
$3,786
$4,000
$3,022
$3,000
$2,675
$2,700
$2,385
$2,223
$1,860
$2,000
$1,000
$0
25-34
35-44
45-54
55-64
Age

Figure 5. Percentage of Medically Underwritten Applicants for Nongroup Coverage
Who Were Denied, 2008
25%
22.2%
20%
14.6%
15%
12.5%
12.0%
10%
5%
0%
25-34
35-44
45-54
55-64
Age

Source: Analyses by America’s Health Insurance Plans (AHIP) of survey of nongroup insurers, described in
“Individual Health Insurance 2009: A Comprehensive Survey of Premiums, Availability, and Benefits,” AHIP
Center for Policy and Research, October 2009, available at http://www.ahipresearch.org/pdfs/
2009IndividualMarketSurveyFinalReport.pdf.
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Putting aside how much of their own expected health care spending the near elderly should pay,
researchers from the Agency for Healthcare Research and Quality (AHRQ) have examined how
much of their after-tax income they do pay for health insurance premiums and out-of-pocket
health care costs.16 Figure 6 shows the percentage of individuals where the family spent more
than 10% of its after-tax income on out-of-pocket health insurance premiums and health care. The
percentage was significantly higher for the near elderly than all the other age groups, regardless
of health insurance, with the exception of 45- to 54-year-olds with private nongroup coverage.
These significant differences occurred because of one or more of three factors affecting the near
elderly: higher out-of-pocket spending on health care, higher out-of-pocket payments for
premiums, and lower incomes. (For additional information, see the Appendix.)
Figure 6. Financial Burden of Health Care and Health Insurance, by
Insurance and Age, 2005

Source: Analysis by Agency for Healthcare Research and Quality (AHRQ) using 2005 Medical Expenditure Panel
Survey (MEPS), based on methods used and described in J.S. Banthin, P. Cunningham, and D.M. Bernard,
“Financial Burden of Health Care, 2001—2004,” Health Affairs, vol. 27, no. 1, January/February 2008, pp. 188-195,
at http://content.healthaffairs.org/cgi/reprint/27/1/188.pdf.
Notes: For more information, see the Appendix. Compared with 55- to 64-year-olds, all other age-group
percentages are significantly different (p<0.05) except for private nongroup in the 44- to 54-year-old category.

16 Estimates provided to CRS by AHRQ, using the same methodologies employed in J.S. Banthin, P. Cunningham, and
D.M. Bernard, “Financial Burden of Health Care, 2001—2004,” Health Affairs, vol. 27, no. 1, January/February 2008,
pp. 188—195, available at http://content.healthaffairs.org/cgi/reprint/27/1/188.pdf.
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Medicare Buy-In
Under current law, individuals are eligible for Medicare if they or their spouse worked for at least
40 quarters in Medicare-covered employment,17 are 65 years old, and are a citizen or permanent
resident of the United States. The near elderly, and other individuals less than 65 years of age,
may also qualify for coverage if they have a permanent disability, have end-stage renal disease
(ESRD),18 or have amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease).19 To best
understand Medicare’s premium and cost sharing structures, it is helpful to know about the
structure of services covered under each part of the program. Part A covers inpatient hospital care,
skilled nursing facilities after a hospital stay, religious nonmedical health care institutions,
hospice services, and home health care services. Part B generally covers outpatient medically
necessary services not covered under Part A, such as physician offices visits. Medicare Part D
covers most self-administered prescription drugs.
With respect to costs, in 2009, most Medicare beneficiaries paid no Part A premiums and $96.40
per month in Part B premiums.20 In 2009, the Part A deductibles were $1,068 for the first 60 days
of inpatient care, $267 per day for 60 to 90 days, and $534 per day for additional days. The Part B
deductible was $135 for the year, and most Part B services also have a 20% coinsurance
payment.21 Premiums and cost sharing in Part D vary by plan, and on average premiums were
about $37 per month for stand alone drug plans in 2009.22 The latest available data indicate that
Part D enrollees had an estimated $48.70 per month in out-of-pocket non-premium drug costs in
2006.23 What a beneficiary actually pays out-of-pocket varies by health status and access to
supplemental coverage. Using the latest data available from the Medicare Current Beneficiary
Survey, the Medicare Payment Advisory Commission (MedPAC) found that, in 2005,
beneficiaries’ average total annual out-of-pocket costs ranged from $873 for Medicare/Medicaid
dual eligibles in good health to $5,796 for beneficiaries with private Medicare supplemental

17 Refers to employment where the individual paid the Federal Insurance Contributions Act (FICA) tax. FICA is a
payroll tax imposed by the federal government on both employees and employers to fund Social Security and
Medicare.
18 ESRD refers to a benefits term for the chronic stage of kidney impairment that is irreversible. Individuals of any age
with ESRD who receive dialysis on a regular basis or a kidney transplant are eligible for Part A (and are deemed
enrolled for Part B unless such coverage is refused) if they file an application. Entitlement usually begins after a 3-
month waiting period has been served, defined as the first day of the third month after the month in which a course of
regular dialysis begins. Entitlement begins before the waiting period has expired if the individual receives a transplant
or participates in a self-dialysis training program during the waiting period.
19 For a more detailed background on Medicare see CRS Report R40425, Medicare Primer, coordinated by Hinda
Chaikind.
20 According to the Centers for Medicare and Medicaid Services, approximately 99% of Medicare beneficiaries do not
pay the Part A premium as a result of having at least 40 quarters of employment paying the FICA tax. However, other
seniors and certain people under age 65 with disabilities who have fewer than 30 quarters of coverage may obtain Part
A coverage by paying a monthly premium of $443 per month for 2009. In addition, seniors with 30 to 39 quarters of
coverage, and certain disabled persons with 30 or more quarters of coverage, pay a premium of $244 per month in
2009. Part B premiums are adjusted upward for beneficiaries who file an individual tax return with income greater than
$85,000 and beneficiaries who file a joint tax return with income greater than $170,000. http://www.cms.hhs.gov/apps/
media/press/factsheet.asp?Counter=3272.
21 “CMS Announces Medicare Premiums and Deductibles for 2009,” CMS Office of Public Affairs, September 19,
2008.
22 CRS Report R40611, Medicare Part D Prescription Drug Benefit, by Patricia A. Davis.
23 Wesley Yin et al. “The Effect of the Medicare Part D Prescription Benefit on Drug Utilization and Expenditures,”
Annals of Intern Medicine, 2008: Vol. 148, P.169-177.
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Health Insurance Coverage of People Aged 55 to 64

coverage and in poor health.24 Thus, depending on supplemental coverage and service utilization
driven by health status, Medicare out-of-pocket costs may or may not be favorable compared to
the out-of-pocket costs for the near elderly in the private marketplace.
One previous proposal to expand insurance access, and reduce costs for the near elderly not
already eligible for Medicare because of a disability, involved expanding eligibility by creating a
Medicare Buy-In (MBI) option. Specifically, on February 2, 1998, President William J. Clinton
proposed allowing Americans between the ages of 62 and 65 to buy into Medicare coverage by
paying a premium based on an actuarially fair rate for that age group.25 The President’s proposal
in the FY1999 budget also called for allowing displaced American workers between 55 and 62
years of age to buy Medicare coverage by paying a premium. The proposal was intended to be
self-financing.
Subsequent to the FY1999 budget release, the Medicare Early Access Act of 1998 was introduced
in the House of Representatives (H.R. 3470) and in the Senate (S. 1789) on February 17, 1998.
These identical bills would have implemented an MBI program for individuals between the ages
of 62 and 65 who are not eligible for coverage under group health plans or public health
insurance, but would be Medicare-eligible if age 65, and for displaced workers and spouses
between the ages of 55 and 62. The bills also would have directed the Secretary of Health and
Human Services to determine premium rates for the program, and would have required the
program to be self-financing through premiums and offsets from fraud and overpayments made in
the rest of the Medicare program. Neither of the bills made it out of committee.
Legislative Activity in the 111th Congress
The Medicare Early Access Act of 2009 (S. 960) was introduced in the Senate on May 1, 2009,
by Senator John D. Rockefeller, IV. The bill would amend Title XVIII of the Social Security Act
to establish a new “Part E” intended to provide access to Medicare benefits for individuals 55 to
64 years of age who do not have coverage under a federal health insurance program or under a
group plan. The bill would require enrollees to pay a premium based on the estimate of the
average, national annual per capita amount of the cost of providing services to the population, as
determined by the Secretary of Health and Human Services. The bill would create the Medicare
Early Access Trust Fund to hold the premiums collected. The bill would also amend the Internal
Revenue Code to allow enrollees to receive a 75% refundable credit to offset Medicare early
access premium costs. Therefore, beneficiaries would be responsible for 25% of the premiums.
The bill was read twice and referred to the Senate Committee on Finance. There are no related
bills in the House of Representatives.
Earlier, Senator Max Baucus released the white paper “Call to Action: Health Reform 2009,”
which proposed an MBI for the near elderly.26 The proposal would establish a temporary MBI
until a health insurance exchange was established. Those already in the MBI would have the
option of remaining in Medicare or choosing a plan in an exchange. The MBI proposal was not

24 “A Data Book: Healthcare Spending and the Medicare Program,” MedPAC, June 2009, http://www.medpac.gov/
document_TOC.cfm?id=428.
25 “Budget of the United States Government, Fiscal Year 1999,” Executive Office of the President, Office of
Management and Budget, February 2, 1998. Available at http://www.gpoaccess.gov/usbudget/fy99/browse.html.
26 Senator Max Baucus “Call to Action: Health Reform 2009,” November 12, 2008. Available at
http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf.
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included as a part of the health reform package developed by the Senate Committee on Finance,
chaired by Senator Baucus. Media reports indicate that an MBI has been discussed as a potential
option within the broader health reform package, although no formal amendments to the existing
health reform bills have been proposed with an MBI for the near elderly.27
Issues for Consideration
Issues involving an MBI program can vary depending on specific elements, such as providing
subsidies for the premiums charged. For example, if MBI premiums are not subsidized, then the
cost of the coverage to potential enrollee will likely be too high and participation rates will
therefore be low. Nevertheless, several common issues are worth considering irrespective of the
specifics of the MBI proposal. The following provides a brief summary of the potential issues:
• Adverse Selection. Adverse selection in health insurance refers to the tendency
of individuals who expect to have high costs to want more insurance in
comparison to those who would expect to have low costs.28 High-cost individuals
could find Medicare particularly attractive since it does not have a restrictive
provider network and generally does not utilize managed care techniques such as
prior authorization.29 If the premiums are affordable, the MBI will likely be even
more attractive to high-cost individuals paying higher premiums in the individual
private market. The result would be skyrocketing premiums in subsequent
coverage years to cover the costs of a disproportionately high-risk pool.
• Costs to the Beneficiary. Since the near elderly are generally a high-risk
population, and Medicare is a fee-for-service insurance plan lacking utilization
management controls, a self-financing MBI program would be expected to have
relatively high premiums. For example, the Congressional Budget Office
estimated that the annual premium for single coverage in 2011 for an MBI for
individuals between the ages of 62 and 64 would be about $7,600.30 Premiums
this high, combined with the cost sharing structure of Medicare, could lead to
out-of-pocket costs similar to, or higher than, what the near-elderly experience in
the private marketplace. Premium costs could be reduced for the beneficiary
through tax credits or by some other subsidy mechanism. Subsidies would,
however, increase the costs of the MBI program.

27 “Pelosi backs Medicare buy-in plan in Senate health-care deal,” by Amy Goldstein, Washington Post, December 11,
2009. Available at http://www.washingtonpost.com/wp-dyn/content/article/2009/12/10/AR2009121004077.html?hpid=
topnews.
28 National Bureau of Economic Research Working Paper 6107, Adverse Selection in Health Insurance, July 1997 by
David Cutler and Richard Zeckhauser.
29 Per 42 CFR § 424.510, health care providers must enroll into Medicare in order to receive payment. This enrollment
process involves a detailed application. For example, see http://www.cms.hhs.gov/CMSforms/downloads/cms855b.pdf
for the clinic and group practice application. Per 42 CFR § 424.530, Medicare can only deny a provider’s enrollment
request for reasons that are not related to cost containment such as the provider has lost his/her license to practice.
Medicare cannot charge additional cost sharing for seeing certain high cost providers. By contrast, private plans
typically attempt to exclude high cost providers from their networks or establish higher cost sharing for high cost
providers in an attempt to incentivize members to use lower cost providers.
30 Congressional Budget Office, Budget Options Volume I: Health Care, December 2008. Available at
http://www.cbo.gov/doc.cfm?index=9925.
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• Cost to the Government. Costs to the government, especially the solvency of
the existing Medicare program, are potential concerns. MBI proposals generally
have called for the establishment of a new trust fund, thus theoretically creating a
firewall between the Medicare expansion for the near elderly and the existing
Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) trust funds.
Nevertheless, the financial pressures on the government could be significant due
to the administrative costs of launching a new program, and if either the MBI
premiums do not fully cover claims costs or if there are premium subsidies.
• Potential Provider Impacts. Medicare payment rates generally are less than
private payers, and may not fully cover provider costs. According to MedPAC,
Medicare payment rates for physicians have held steady at about 80% of
payments made by private insurance companies between 2000 and 2008.31 This
differential could be an incentive for physicians to seek more private pay patients
with a higher payment rate, thus potentially limiting access for Medicare
beneficiaries. With respect to hospitals, MedPAC reports that the overall
Medicare margin32 has trended downward since 1997 and has been negative since
2003.33 Similarly, the financial pressures on hospitals could limit access to
Medicare beneficiaries.
• Potential Impacts on Private Insurance. If providers see reduced revenue due
to having more patients at the lower Medicare payment rates they may in turn
place additional pressure on private insurance plans to make up the difference.
This phenomenon, called cost shifting, can result in higher premiums for
individuals in the private insurance marketplace. “Crowd out” or the substitution
of public health insurance for private health insurance could also be a concern if
the MBI accepts currently insured individuals.34 Crowd out can either harm the
private sector market by reducing needed revenues, or it can result in increased
profit margins by removing high cost individuals from the risk pool.
• Incentivizing Early Retirement. The near elderly may continue working in
order to have access to employer sponsored health insurance. Extending
Medicare to this group may be an incentive for early retirement, thus placing
additional cost pressures on public retirement programs, and reducing
employment and income related tax revenues.

31 “Assessing payment adequacy: Physician services” presentation by Cristina Boccuti, Hannah Neprash, and Kevin
Hayes, December 10, 2009. Available at http://www.medpac.gov/transcripts/Physician%20Dec%2009%20pub.pdf.
32 Refers to the difference between the Medicare payment amount and the hospital’s costs for treating Medicare
beneficiaries. This is a measure of profitability for Medicare patients served by the hospital.
33 “Medicare Payment Policy: Report to Congress,” Medicare Payment Advisory Commission, March 2009.
34 The Medicare Early Access Act of 2009 proposal would not accept those with private group health plan coverage,
but would accept persons with insurance from the individual market.
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Appendix. Technical Data
Figure 5 in the main body of this report shows the percentage of individuals where the family
spent more than 10% of its after-tax income on out-of-pocket health insurance premiums and
health care. Table A-1 below shows the detailed estimates on which the figure is based.
These estimates, broken down by age, were provided upon request by the Agency for Healthcare
Research and Quality (AHRQ), using data from the 2005 Medical Expenditure Panel Survey
(MEPS). Their methodology is described in detail in J.S. Banthin, P. Cunningham, and D.M.
Bernard, “Financial Burden of Health Care, 2001-2004,” Health Affairs, volume 27, number 1,
January/February 2008, pp. 188-195, available at http://content.healthaffairs.org/cgi/reprint/27/1/
188.pdf. The following descriptions summarize the relevant portions of the methodology
described in the Health Affairs article.
The dollar amounts for income (after taxes) and for out-of-pocket health care spending and
premiums are all measured at the family level. “Family income” defined this way is more
precisely referred to as the income of “health insurance units” (HIU), which generally consists of
the income of the individual, spouse, and dependent children. The HIU definition of family
income is often considered more useful for health-policy analyses, because it tends to mirror
eligibility and available resources for family coverage in the private market. It also reflects the
definition of family income for some means-tested public programs. Ultimately, the resulting
population estimates are reported at the person level; each person in the analysis is assigned the
family-level measures.35
Everyone in the analysis was classified into a single category for their health insurance status.
First, if they were without coverage all year, they were considered uninsured. Coverage was then
assigned based on the number of months individuals had that type of coverage. Premiums
amounts were prorated as necessary to account for the duration of coverage during the year.
Although medians are often used for analyses of income and expenditures, Banthin et al. use
averages instead for a number of reasons—primarily so that the individual out-of-pocket amounts
add to the total in each category. For additional detail on the methodology, one may refer to the
Health Affairs article.

35 The uninsured in Table A-1 show positive out-of-pocket premium amounts. This is because, again, the dollar
amounts are compiled at the family level. The positive out-of-pocket premium amounts reflect amounts paid by insured
family members.
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Table A-1. Percentage of Adults in Families with Out-of-Pocket Spending on Health Care and Health Insurance Premiums
Exceeding 10% of After-Tax Income, by Insurance and Age, 2005
Private Group
Private Nongroup
Public
Uninsured
Margin
Margin
Margin
Margin
Age Characteristic
Average
of error

Average
of error

Average
of error
Average
of error
Total
After-tax family income
$59,343
± $1308

$52,499
$2,166

$17,331
$462

$26,790
$866

25-64
OOP spending on care
$1,394
± $58
*
$2,071
$234

$1,226
$204
*
$1,016
$71
*

OOP premiums
$2,041
± $93
*
$4,549
$223
*
$227
$20
*
$160
$16

Total OOP burden
$3,435
± $116
*
$6,620
$335
*
$1,453
$205
*
$1,176
$75
*

% in families w/ high burdens
18.7%
± 1.1%
*
52.6%
± 5.6%
*
25.0%
± 2.6%
*
15.2%
± 1.8%
*
25-34
After-tax family income
$50,841
± $2086
*
$42,092
$4,040

$17,928
$748

$22,922
$933

OOP spending on care
$798
± $66
*
$1,052
$185
*
$336
$48
*
$499
$43
*

OOP premiums
$1,505
± $105
*
$2,239
$240
*
$90
$15
*
$115
$25

Total OOP burden
$2,304
± $132
*
$3,291
$371
*
$427
$53
*
$614
$51
*

% in families w/ high burdens
12.2%
± 1.8%
*
34.2%
± 12.2%
*
11.3%
± 3.4%
*
10.6%
± 2.5%
*
35-44
After-tax family income
$63,160
± $2234
*
$55,895
$3,995

$17,948
$1,053

$29,045
$1,428

OOP spending on care
$1,248
± $98
*
$1,310
$182
*
$1,728
$805

$1,007
$112
*

OOP premiums
$2,164
± $176

$3,707
$390
*
$133
$28
*
$158
$37

Total OOP burden
$3,412
± $197
*
$5,017
$477
*
$1,861
$805

$1,165
$119
*

% in families w/ high burdens
16.4%
± 1.8%
*
40.8%
± 13.2%
*
18.9%
± 5.2%
*
13.5%
± 3.3%
*
45-54
After-tax family income
$63,151
± $1820
*
$58,924
$4,532

$16,615
$791

$30,814
$1,724
*

OOP spending on care
$1,654
± $99
*
$3,147
$762

$1,137
$125
*
$1,320
$164

OOP premiums
$2,101
± $147
*
$5,682
$474

$277
$47
*
$198
$33

Total OOP burden
$3,756
± $196
*
$8,830
$946

$1,414
$142
*
$1,518
$174

% in families w/ high burdens
19.4%
± 2.1%
*
60.8%
± 10.5%

28.5%
± 5.2%
*
17.0%
± 3.5%
*
CRS-18

Private Group
Private Nongroup
Public
Uninsured
Margin
Margin
Margin
Margin
Age Characteristic
Average
of error

Average
of error

Average
of error
Average
of error
55-64
After-tax family income
$58,396
± $2456

$51,905
$3,454

$16,761
$1,071

$25,674
$1,597

OOP spending on care
$1,894
± $155

$2,432
$236

$1,776
$191

$1,743
$283

OOP premiums
$2,381
± $187

$5,975
$510

$437
$61

$210
$41

Total OOP burden
$4,275
± $248

$8,406
$568

$2,214
$213

$1,953
$286

% in families w/ high burdens
28.0%
± 2.6%

68.7% ±
8.2%

43.9% ±
5.4%

25.4% ±
5.2%

Source: Analysis by Agency for Healthcare Research and Quality (AHRQ) using 2005 Medical Expenditure Panel Survey (MEPS), based on methods used and described in
J.S. Banthin, P. Cunningham, and D.M. Bernard, “Financial Burden of Health Care, 2001—2004,” Health Affairs, volume 27, number 1, January/February 2008, pp. 188—195,
available at http://content.healthaffairs.org/cgi/reprint/27/1/188.pdf.
Notes: The margins of error are calculated based on a 95% confidence interval. An asterisk indicates estimates that are significantly different from those in the 55-64-year-
old category (p<0.05). “OOP” means out-of-pocket. “High burdens” means total out-of-pocket spending on health care and health insurance premiums exceeds 10% of the
family’s after-tax income.

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Health Insurance Coverage of People Aged 55 to 64

Author Contact Information

Chris L. Peterson
Mark Newsom
Specialist in Health Care Financing
Analyst in Health Care Financing
cpeterson@crs.loc.gov, 7-4681
mnewsom@crs.loc.gov, 7-1686

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