The number of seniors over 85 who rely on Medicare alone is significant but varies depending on individual circumstances such as income, health status, and availability of supplemental insurance. Medicare is the primary health insurance program for Americans aged 65 and older, including those over 85, but many seniors supplement it with additional coverage to manage costs and care needs.
Medicare coverage begins at age 65 and provides essential health insurance, but it does not cover all medical expenses. For seniors over 85, healthcare costs tend to be much higher than for younger seniors, often two to three times greater, due to increased medical needs and chronic conditions. Medicare spending per beneficiary rises with age, with average annual costs for those 85 and older reaching well over $16,000, reflecting more frequent hospitalizations, specialist visits, and long-term care needs.
Despite Medicare’s broad coverage, many seniors over 85 do not rely solely on it. A substantial portion purchase Medigap (Medicare Supplement Insurance) or Medicare Advantage plans to cover gaps such as copayments, deductibles, and services not fully covered by Medicare Parts A and B. These supplemental plans help reduce out-of-pocket expenses, which can otherwise be substantial given the high healthcare utilization in this age group.
However, there is a notable subset of seniors over 85 who do rely on Medicare alone without additional insurance. This group often includes individuals with limited income and assets who may not afford or choose not to purchase supplemental coverage. Median income for Medicare beneficiaries aged 85 and older is lower than for younger seniors, and many have limited financial resources, though home equity tends to be higher in this age group due to paid-off mortgages.
Long-term care is a critical factor influencing reliance on Medicare alone. While Medicare covers some short-term skilled nursing and rehabilitation services, it does not cover most long-term custodial care, which is often needed by seniors over 85. Many in this age group depend on Medicaid, family caregivers, or pay out-of-pocket for long-term care services. This gap means that Medicare alone may not be sufficient for comprehensive care, pushing many seniors to seek additional coverage or assistance.
In summary, while Medicare is the foundational health insurance for seniors over 85, the proportion relying exclusively on it without supplemental coverage is limited by the high costs and care needs typical of this age group. Many supplement Medicare with additional insurance or rely on other resources to manage the extensive healthcare and long-term care expenses that come with advanced age.
