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The Affordable Care Act and Older Adults

The Affordable Care Act (ACA) – now over a decade old – has played a critical role in expanding access to health coverage for older adults ages 50 to 64. As a result of its reforms, fewer older adults in this age group are uninsured and more are enrolled in nongroup (individual) health insurance coverage. However, many older adults in the nongroup market still face high health care costs.

A new Insight on the Issues explores affordability challenges facing 50- to 64- year-olds who rely on the nongroup market, including unaffordable premium and out-of-pocket costs. The paper presents national and state-level data and concludes with several policy recommendations to address these affordability challenges.

Key Affordability Challenges Facing Older Adults Ages 50 to 64:

  • Among older adults not eligible for employer-based or public health coverage, almost half remain uninsured (5.5 million).
  • 40 percent of older nongroup enrollees face unaffordable health coverage.
  • As health costs increase, the share of older nongroup enrollees without subsidies is shrinking.
  • The subsidy “cliff” presents a significant affordability challenge for many older nongroup enrollees.
  • Older nongroup enrollees face higher premiums and out of pocket costs than younger enrollees.
  • Unaffordable coverage leads to delaying or forgoing care by older adults, and greater numbers of uninsured

More state-level data on the uninsured and nongroup market is also available on AARP DataExplorer, an interactive data visualization tool from AARP Public Policy Institute.

50 state fact sheets with state-level data enrollment and affordability issues among older nongroup enrollees.

Previous Reports:

Two earlier fact sheets examined characteristics of and enrollment trends among older adults. 

1)   Characteristics of Americans Ages 50 to 64 in the Nongroup Health Insurance Market

Key Take-Aways:

  • Older adults in the nongroup market represent a similar racial and ethnic makeup to the rest of the market.
  • Most older adults in the nongroup market are working and are in good health.
  • Only a small proportion of older adults with incomes just above eligibility for financial assistance are enrolled in nongroup coverage. 

2)   Enrollment and Coverage Trends for Americans Ages 50 to 64 in the Nongroup Health Insurance Market

Key Take-Aways:

  • Older adults rely heavily on the nongroup health insurance market. Nine percent of Americans ages 50 to 64 (5.6 million) are enrolled in the nongroup market.
  • Older adults make up a disproportionately high share of this market. The nongroup market is also getting older over time, as the proportion of adults ages 50 and older is growing.
  • Because of the ACA, the uninsured rate among older adults has fallen 39 percent since 2013 as coverage has increased in the nongroup market.
  • Trends shifted in 2017 and 2018, reflecting market uncertainty and federal policy changes. Between 2016 and 2018, the uninsured rate among older adults ages 50 to 64 increased slightly and nongroup enrollment decreased.

Suggested citations:

Jane Sung, Olivia Dean, Robert C. Saunders, Asha Saavoss, and Lane Koenig. How Unaffordability of Nongroup Health Insurance Threatens the Health Security of Older Adults. Washington, DC: AARP Public Policy Institute, November 2020. https://doi.org/10.26419/ppi.00114.001

Sung, Jane, Olivia Dean, Asha Saavoss, and Robert C. Saunders. Characteristics of Americans Ages 50 to 64 in the Nongroup Health Insurance Market. Washington, DC: AARP Public Policy Institute, March 2020. https://doi.org/10.26419/ppi.00099.001

Sung, Jane, Olivia Dean, Asha Saavoss, and Robert C. Saunders. Enrollment and Coverage Trends for Americans Ages 50 to 64 in the Nongroup Health Insurance Market. Washington, DC: AARP Public Policy Institute, March 2020. https://doi.org/10.26419/ppi.00099.002