Working with countless disabled and homebound older adults, Namkee G. Choi, PhD, sees many who live with no health insurance. After the onset of disability in their 50s, people could no longer work and lost their coverage.

“Eligibility for Medicare and/or Medicaid is tough, and many did not have it for many years when they needed it the most,” says Choi, chair of gerontology at the school of social work at The University of Texas at Austin.

More “near older” patients (age 50 to 64 years) with chronic health conditions are putting off needed care they cannot afford, according to the authors of an analysis.1 Researchers found lack of coverage is a particular problem for this group, which lives with more chronic health conditions than younger groups, but is not old enough for Medicare. Their income, especially for those who still work part or full time, is too high to qualify for Medicaid.

Researchers analyzed data from 2013 to 2018, and discovered that near-older adults without health insurance were at least seven times more likely as other patients to have gone without needed care because of cost constraints. “The main takeaway was that if you’re an older American without health coverage, you’re going to have less access to healthcare,” says Choi, the study’s lead author. Other key findings:

  • Many of these individuals still worked, but their jobs either did not provide healthcare benefits or paid too little to help employees afford better coverage (yet paid too much to qualify for other aid);
  • The chance of living with no coverage was much higher among racial/ethnic minorities.

Diana M. DiNitto, PhD, another study author, says financial counselors can help direct patients without insurance to federally qualified health centers (outpatient clinics that receive funding to provide primary care services in underserved areas). By addressing acute and chronic care needs, the hope is these patients can avoid unnecessary ED visits or hospital stays altogether.

“This may take substantial effort on the part of counselors,” says DiNitto, professor of alcohol studies and education at the University of Texas at Austin school of social work.

Local governments and community programs offer additional resources. In Travis County, TX, there is the county government-funded Medical Access Program for low-income people. “Some of my low-income homebound older adult clients benefit from that,” DiNitto reports.

Additionally, the Texas Adult Protective Services offers emergency community service funds that case managers can use for medications for older adults. This is helpful even if patients are on Medicaid. The number of medication prescriptions that a Medicaid beneficiary can fill per month varies widely among state Medicaid programs. “In Texas, the number is just a few. Many older adults on Medicaid go without necessary medications,” DiNitto observes.

Bryan Choi, MD, MPH, another study author and an assistant professor of emergency medicine at Brown University, says, “uninsured and underinsured people still have access to the healthcare safety net. But this isn’t a substitute for full access.”

Patients with comprehensive coverage can access all the care they need without incurring significant financial hardship. This includes primary care, mental care, prescription coverage, specialty care, and dental care.

“Specialty care and dental care in particular are things that the underinsured and uninsured have trouble obtaining in a timely fashion, from my professional experience,” Choi shares.

For example, an ED physician can recommend that a patient see an oral surgeon for a fractured tooth. However, there may be no surgeons in the area willing to take Medicaid or certain “nonpremium” insurance plans. “Then that’s a problem for that patient,” Choi adds.


  1. Choi NG, DiNitto DM, Choi BY. Unmet healthcare needs and healthcare access gaps among uninsured U.S. adults aged 50-64. Int J Environ Res Public Health 2020;17:2711.