The health care penalties of growing old


By Al Norman

alnorman_headshotIn late September, the Blue Cross Blue Shield Foundation released two reports regarding health care for seniors in Massachusetts. The first report found that while a large majority of seniors are satisfied with the healthcare, over 25 percent of older adults were dissatisfied with healthcare costs, and more than 20 percent said it has become harder to pay for healthcare services or prescription drugs over the past five years. Both concerns are higher among seniors who report poor health or a disability.

Dissatisfaction is highest among elders who are in fair or poor health or have a medical condition that substantially limits one or more basic physical activities like walking. Thirty-three percent of these seniors in poorer health report dissatisfaction with their healthcare costs and say that paying for care has gotten harder in the past five years. Among those seniors in poorer health who had problems affording healthcare, the top two reported problems were paying for prescription drugs and the cost of premiums, deductibles and co-pays.

Financial insecurity due to healthcare costs is also felt among older adults in households living on $25,000 or less per year, more than one-third of whom say they are not confident they will have enough money or insurance to afford the healthcare they may need in the future. About 11 percent of seniors in poorer health report spending all or most of their personal savings or taking on credit card debt that may be difficult to pay off. By comparison, only 1 percent of seniors in better health report having similar financial circumstances. Eighteen percent of seniors in poorer health report having not filled a prescription in the past year due to cost, whereas 8 percent of their peers in better health report having had to do this. Fifteen percent of seniors in poorer health report cutting pills in half or skipping doses of medicine due to the cost of prescription drugs, as compared with only 2 percent of seniors in better health. Twelve percent of seniors in poorer health report not having had a medical test or treatment they needed due to cost. In contrast, only 5 percent of their peers in better health report having skimped on health care services.

In a second report released by the Blue Cross Blue Shield Mass. Foundation, the disparity between people over age 65 and those younger regarding the income and asset eligibility rules show that its harder for elders to get on MassHealth. The income cutoff for MassHealth eligibility is lower for elders than for people under age 65, and even at the same income level, elders may have less access to affordable health coverage than non-elders because of asset tests for public programs that do not apply to younger individuals. Under the state’s health reform law and the Affordable Care Act, affordable health coverage is available to most people in the state with incomes below 300 percent of the federal poverty level (FPL). Eligibility for ConnectorCare and for MassHealth for non-elders is based solely on income – no asset test applies. But for people age 65 or older, the MassHealth program has an asset limit of only $2,000. Eligibility for public coverage ends at 135 percent of the federal poverty level for elders residing in the community, compared with 300 percent FPL for people younger than age 65. Only 16 percent of elders in Massachusetts are covered by MassHealth, compared with 31 percent of people under age 65 who have either MassHealth or ConnectorCare.

These eligibility rules are a blatant form of age discrimination. Older people need more healthcare services than younger people – yet right when they need health care the most, it’s harder for seniors to get the care they need. Recently elder advocates tried to get the State Legislature to raise the income eligibility level for the home care program from $27,000 to $35,000 – which happens to be 300 percent of the federal poverty level. Younger people already can get care at 300 percent of FPL, but the General Court was not willing to give elders equal treatment.
Being poor and elderly is a double whammy for healthcare. The results of these surveys should compel the state to stop punishing people for surviving past 65 years of age.

Al Norman is the executive director of Mass Home Care. He can be reached at, or at 978-502-3794. Archives of articles from previous issues can be read at