The Burden of High Health Care Costs for Midlife Adults with Private Insurance

High health care costs affect consumers of all ages and with all types of health coverage, including those with private insurance as well as those without insurance. The burden is particularly felt among midlife adults ages 50 to 64 who face higher rates of chronic conditions and are more likely to need health care services than younger adults. Most midlife adults (76 percent) have private health insurance, either through an employer or through a nongroup or individual health insurance plan.

This brief is the first in an AARP Public Policy Institute series exploring the issue of high health care costs and how they affect adults ages 50 to 64. Its key takeaways are:

• Health care costs are high in the United States, and officials project them to increase over the next decade. Unit prices for health care services are rising rapidly.
• The burden of high health care costs falls heavily on midlife adults ages 50 to 64, who are more likely to have higher health care needs.
• Data show that privately insured midlife adults—those enrolled in employer-sponsored insurance or nongroup (individual) health coverage—pay higher premiums and out-of-pocket expenses relative to adults of other ages.
• These high costs are making health care unaffordable for many midlife adults and forcing many to make difficult choices about their care (e.g., skipping appointments, stretching prescriptions to last longer) or go into medical debt. 
• Although state and federal policymakers have made some effort to contain health care costs, they should pursue innovative strategies to reduce health care costs while making sure to maintain the quality of and access to care for consumers. 

The brief includes detailed data and discussions, organized in the following sections:

National spending on health care is high and growing

Over the past 50 years, US spending on health care has increased from $74 billion, representing 7 percent of the national gross domestic product (GDP), to $4.5 trillion, representing 17 percent of the GDP. Recent increases in health care spending are a function of growth in both unit prices (how much providers charge for their services) and utilization (how much medical care consumers are accessing and using). Notably, improvements in health outcomes have not risen alongside the growth in spending.

As health care costs rise, midlife adults and employers pay more

Having private health insurance does not fully insulate midlife adults from high health care costs. Midlife adults with private insurance, as well as employers that provide this coverage, are vulnerable to rising health care costs and are paying more for care. An AARP Public Policy Institute and NORC at the University of Chicago analysis found that:

• Midlife adults pay high premium costs and those costs grew faster than premiums paid by other adults.
• Annual out-of-pocket costs are higher for midlife adults than for adults of other ages.
• Total employer contributions have increased alongside employee premiums, forcing some employers to consider whether to absorb these costs or pass them along to employees.

Higher costs are constraining health care affordability

In 2021, one-fifth (or 2.3 million) of midlife insured adults with single plans spent more than 10 percent of their gross income on health care costs. Comparatively, only 13 percent of adults ages 18 to 34 (1 million) and 11 percent of adults ages 35 to 49 (1.2 million) spent more than 10 percent of their gross incomes on health care.

Read the paper for full discussions of cost and affordability.

High health care costs pose challenges for many midlife adults

Difficult choices: One-third of adults ages 50 and older report problems paying for health care in the past year. In a 2022 AARP survey, close to half (47 percent) of respondents ages 50 to 64 reported delaying or forgoing care (primary, dental, and vision) in the past year because of cost. Twenty-nine percent reported stretching out a prescription, cutting pills in half, or not filling a prescription in the past year due to cost. Many forgo other necessities in order to cover needed health care.

Medical debt: In 2022, 7.2 million midlife adults (11 percent) had medical debt; 20 percent of them carried debt over $10,000. In some cases, the debt is for a family member’s care.

Controlling high health care costs for midlife adults

Health care costs are multifaceted, and no one factor is responsible for the increases in health care costs. Factors that have contributed over the past few decades include:

1. the development, acquisition, and integration of new medical devices and technologies
2. rising prices due to a number of factors including the continued concentration of the health care sector through the consolidation and acquisition of providers by other providers, corporations, and private equity
3. the widespread lack of transparency that makes it difficult for employers, other payers, and consumers to know how much they are paying for care
4. excessive price inflation for certain products, prescription drugs, and medical devices

Meaningful policy solutions, discussed in this brief, could help constrain health care costs and lift the cost burden on consumers, including midlife adults.