John Galvin knows he needs a colonoscopy. But he鈥檚 waiting to schedule the procedure until December, when he turns 65 and qualifies for Medicare.
He was already thinking about delaying it 鈥� then his monthly Obamacare insurance premium payment tripled this year to $2,460, about a third of his income, he said. And with a $2,700 deductible, he鈥檇 be on the hook for most of the diagnostic exam, a financial hit he said he couldn鈥檛 stomach.
鈥淚t was going to cost close to $3,000,鈥� said Galvin, who lives in North Kingstown, Rhode Island, and recently retired as director of a durable medical equipment company. 鈥淚 put it off.鈥�
Galvin said his wife, Nancy, is delaying a costly CT scan for a few years until she too qualifies for Medicare, so it can foot the bill. The federal health program offers coverage for all Americans 65 and older.
People on Affordable Care Act plans nearing retirement age experienced some of the largest price increases following the expiration of enhanced federal subsidies at the end of December. Those with incomes above 400% of the federal poverty level 鈥� 鈥� had been getting help paying for the plans since the Biden administration expanded the subsidies during the covid-19 pandemic. Adults ages 50 through 64 of those ACA enrollees.
Now, without that federal financial help, some in this age group say they鈥檙e wrestling with whether to delay care until they qualify for Medicare. Not only does that put their physical health at risk, said patient advocates, doctors, and health policy researchers, but it potentially just shifts the costs 鈥� and could lead to taxpayers鈥� footing even bigger bills to fix health issues that worsen amid the delays.
鈥淭here鈥檚 going to be a lot of pent-up demand and unmet need,鈥� said , a health policy consultant who worked in the Obama and Biden administrations. 鈥淢edicare is going to have to spend a whole heck of a lot of money covering and dealing with their treatment.鈥�
The Affordable Care Act has been a key source of health care coverage for people 50 through 64. Access to Obamacare plans helped cut the uninsured rate for this age group by half, , a lobbying group that represents older adults. That allowed some people to retire early while keeping coverage. It also has provided a safety net for small-business owners and those with jobs that don鈥檛 offer health insurance.
Last fall, the longest-ever government shutdown occurred amid an unsuccessful effort by Democrats to extend the enhanced subsidies. Republicans opposing the extension had said the assistance went to insurers, incentivizing fraud and wasteful coverage.
The issue will continue to have political relevance, especially in this year鈥檚 midterm elections, including among older Americans who reliably show up to the polls, said Republican strategist , who runs the Atlas Strategy Group.
鈥淚s affordability going to be an issue? Absolutely,鈥� he said. 鈥淎re health care prices going to factor into that? Yes.鈥�
Even before the subsidies expired, the costs of medical care, nursing homes, and prescription drugs were among the top health-related concerns for people over 50, a found.
Middle-aged adults with Obamacare plans acutely feel the pinch of the expired subsidies, because to charge adults in their 60s up to three times as much for premiums as those in their 20s, who generally use fewer medical services.
And many middle-aged adults were already enrolled in the lowest-cost plans available, which leaves them without cheaper options to fall back on, said , a policy analyst with 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News.
鈥淭his is very dire for the older marketplace enrollees,鈥� he said.
Someone making a few dollars over 400% of the federal poverty level earns too much to get a subsidy now, and in some states average premium payments were due to for this group. Many people are seeing yearly rate increases of thousands of dollars, with premium payments totaling as much as a quarter of their incomes.
, a primary care physician and health policy researcher at the University of Michigan, said he has regular conversations with older patients who are trying to figure out how to afford their medical care. Some in their early 60s are likely to drop ACA coverage because of rising premiums, he said.
鈥淭hat鈥檚 a gamble,鈥� he added.
Marci Heinbaugh may take that bet. The 63-year-old social services worker, who lives in rural Illinois, said her monthly premium payments more than doubled, from roughly $1,100 to $2,333, for a plan with a $10,150 out-of-pocket maximum.
She knew she鈥檇 be paying more, she said, but wasn鈥檛 anticipating that kind of increase. A few months in, she鈥檚 not sure if she鈥檒l stick with the plan for the rest of the year. She said she may go uninsured.
鈥淚鈥檓 petrified to even think about that,鈥� Heinbaugh said.
People want to buy their own insurance on the marketplace, and many middle-aged adults could afford it with just a little federal financial help, said , senior vice president of public policy at AARP. Those who drop coverage or delay care until they reach age 65 might save money now, but that could be more costly for them 鈥� and taxpayers 鈥� later.
鈥淭here鈥檚 significant possibility that the purported savings associated with reducing subsidies as people approach retirement end up turning into higher utilization costs for Medicare,鈥� Weil said.
And Medicare enrollees aren鈥檛 insulated from rising costs. In January, for example, standard Medicare from $185 per month to almost $203.
Until Galvin joins Medicare, he said, he expects to burn through a $30,000 retirement account to cover his marketplace plan鈥檚 premium payments and deductible.
A found that 1 in 5 adults over 50 had no retirement savings and 3 in 5 were worried they wouldn鈥檛 have enough retirement savings to support themselves.
The expiration of these Obamacare subsidies puts additional financial pressure on Americans as they approach retirement, health policy researchers said.
鈥淚t鈥檚 forcing people to make impossible choices,鈥� said , director of federal health advocacy for the national nonprofit Justice in Aging.
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