Surprising number of U.S. elders do not have health insurance coverage – not even Medicare


Contact: Maureen Maxwell
(202) 232-9033 or (800) 274-2237, ext. 2560

WASHINGTON—About 354,000 uninsured people 65 years and older in the United States had no health insurance in 2000 -- approximately 1.1 percent of the country’s elderly. The uninsured elderly were more likely to be relatively younger (65 to 74 years old) and to be unmarried (divorced, widowed or never married). The proportion of African American, Asian American and/or Hispanic uninsured exceeded their proportion of the general population.

"Who Are the Uninsured Elderly in the United States," a snapshot of the uninsured elderly, came from the Robert Graham Center: Policy Studies in Family Medicine and Primary Care in Washington, D.C. It was published in the April edition of the Journal of the American Geriatrics Society.

"Because of the Medicare program, it is commonly assumed that all older Americans have health insurance coverage," said James W. Mold, M.D., M.P.H., lead author and a family physician and professor of family medicine. "However, there are hundreds of thousands who do not have coverage, and that number is expected to grow. Is this what we want for our parents, our neighbors or ourselves?"

The researchers sought to describe the size, socio-demographic characteristics and health status of the uninsured elderly in America. The research revealed:

In 2000, 72.3 percent of the uninsured were age 65 to 74; only 54.4 percent of those with insurance were in that age group. 24.3 percent of the uninsured were 75 to 84, compared with 36.2 percent of the insured; and 3.4 percent of the uninsured were 85 or older, compared with 9.4 percent of the insured.

Gender did not vary greatly between the uninsured and the insured. 55.5 percent of the uninsured were women, while 57.5 percent of elderly who had insurance were women. 44.5 percent of the uninsured were men, and 42.5 percent of the insured were men.

Marital status varied significantly between the two groups. The uninsured were more likely to be widowed (40.1 percent of the uninsured compared with 32.4 percent of the insured) or never married (6.9 percent compared with 3.5 percent). The uninsured were far less likely to be married (40.8 percent of the uninsured were married compared with 57 percent of the insured).

Certain racial populations made up a greater proportion of the uninsured than the insured. 16.6 percent of the uninsured were African-American, compared with 8.1 percent of those with insurance. 13.4 percent of the uninsured were Asian and Pacific Islanders, compared with 2.1 percent of the insured. However, 60.8 percent of the uninsured were Caucasian, and 87.9 percent of elderly with insurance were Caucasian. For comparison, in 2000 8.15 of all elders in the U.S. (65 and older) were African-American, 2.21 percent were Asian and Pacific Islanders, and 87.57 percent were Caucasian.

The proportion of the uninsured who were Hispanic was 35.8 percent, compared with 5.5 percent of those with insurance.

Well over half – 55.8 percent – of the uninsured were born outside the United States, while 10.4 percent of those with insurance were born outside the country. 51.3 percent of the uninsured were U.S. citizens and 98.1 percent of the insured were U.S. citizens.

Based on self-rated health status, uninsured elders enjoyed similar to slightly better health than those with insurance. The uninsured were, however, far less likely to have used office-based care, home health care, and phone advice, and they were less likely to have been admitted to a hospital.

16.1 percent of the uninsured and 4.4 percent of the insured did not receive and/or delayed receiving needed medical care because of the cost.

"The lack of attention to the uninsured elderly is probably a result of the much greater numbers of uninsured children and work-aged adults in this country and the assumption that Medicare covers everyone over 65," wrote the authors. "The oversight is, however, unjustified since the elderly as a group use substantially more medical care resources than children and younger adults. Thus their need for insurance is greater, and their numbers are growing faster than any other age group."

"The United States needs a system of universal access to basic health care to meet the needs of the increasing numbers of disenfranchised Americans of all ages, and we as a people need to revisit decisions regarding who to consider Americans for purposes of health care coverage," the researchers recommended.

# # #

Note to journalists: To interview Dr. Mold, or to obtain a copy of the article, please contact Maureen Maxwell at (202) 232-9033, (800) 274-2237, or

The Robert Graham Center conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in 1999, the Center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians. For more information, please visit

The information and opinions contained in research from the Robert Graham Center do not necessarily reflect the views or policy of the AAFP.

April 01, 2004