Rising health insurance premiums following the expiration of federal subsidies are forcing many middle-aged Americans to delay necessary medical procedures until they qualify for Medicare at age 65, according to a report by KFF Health News.
The trend is particularly acute among adults aged 50 to 64 who are enrolled in Affordable Care Act (ACA) plans. Following the expiration of enhanced federal subsidies in December, some enrollees with incomes above 400% of the federal poverty level saw their monthly premiums triple.
John Galvin, a 64-year-old retiree in Rhode Island, is among those currently forgoing care. Galvin needs a colonoscopy but is waiting until he turns 65 in December for Medicare to cover the procedure. His monthly Obamacare premium payment jumped this year from $800 to $2,460, consuming roughly a third of his income.
“It was going to cost close to $3,000,” Galvin told KFF, referring to the cost of the diagnostic exam under his current plan’s $2,700 deductible. “I put it off.”
Health policy researchers warn that these delays could lead to higher long-term costs for taxpayers. “There’s going to be a lot of pent-up demand and unmet need,” Jessica Schubel, a health policy consultant who served in the Obama and Biden administrations, told KFF.
“Medicare is going to have to spend a whole heck of a lot of money covering and dealing with their treatment.”
The subsidies, which were expanded during the COVID-19 pandemic, expired after a government shutdown last fall following a failed effort by Democrats to extend them. Republican opponents of the extension argued the assistance incentivized fraud and wasteful coverage.
Matt McGough, a policy analyst with KFF, described the current situation as “very dire for the older marketplace enrollees.” According to the sources, the ACA allows insurers to charge adults in their 60s up to three times as much for premiums as those in their 20s.
“It’s forcing people to make impossible choices,” Natalie Kean, director of federal health advocacy for the nonprofit Justice in Aging, told KFF.
A 2024 University of Michigan poll found that the costs of medical care and prescription drugs were already top concerns for people over 50 even before the subsidies expired.