Dan had a silly cough that just wouldn’t quit. He attributed it to allergies that came with Midwest living. Dan was self-employed, so at 63-years-old he could wait for Medicare eligibility to kick in. There was no need to spend hard earned money on a doctor to tell him he had post-nasal drip. When he finally got his Medicare, Dan thought it was a good enough time to get things checked out.
Three months after Dan turned 65, he was diagnosed with Stage III lung cancer. Instead of saving money, waiting to seek medical care cost him years of his life. Unfortunately, Dan’s case is not unique. Physicians have noticed a trend in near-elderly adults (61-64 years old) postponing preventative or diagnostic healthcare visits until they reach Medicare eligibility. The consequences of waiting are dire and may literally mean life or death.
Medicare is a federal health insurance program for adults 65 and older and eligible individuals under 65 with certain disabilities. Over 44 million seniors were enrolled in traditional Medicare at the end of 2020. An individual’s 65th birthday marks the date that eligibility for Medicare begins. It is estimated that up to 20% of those nearing elder years are uninsured in the time prior to Medicare eligibility. When a Stanford University physician noticed that 65-year old patients were diagnosed with cancer at a higher rate than those at 64 or 66 years old, he looked to Medicare eligibility as a possible reason.
Doctor Joseph Shrager is a Professor of Cardiothoracic Surgery Stanford School of Medicine. Shrager and his colleagues performed a cursory analysis and found a twofold increase in surgery for lung malignancy among their patients at the age of 65 than with patients just one year younger. These scientists wanted to know if this would hold true on a larger scale.
Results of Shrager’s follow-up study were published in the journal Cancer in March 2021. Researchers “identified an abrupt and statistically significant rise in cancer diagnoses at the age of 65 years and a subsequent drop in diagnoses in the years immediately thereafter.” The results supported their conclusion that “patients are delaying cancer-related diagnostic and therapeutic interventions until they become Medicare-eligible.”
In essence, while the universal coverage offered by Medicare has a positive impact on its user’s health, there is a negative consequence to waiting for eligibility before seeking healthcare intervention. The near elderly do have options for temporary or gap insurance to bridge the time until Medicare becomes available.
Instead of putting off your visit to the doctor until after your 65th birthday, consider these alternative health insurance options.
Consider COBRA coverage
COBRA coverage is also available for you to retain health insurance through a former employer. The law requires that COBRA insurance be made available immediately after you leave your job. It is costly, as you will pay the entire cost of the policy plus an administrative fee. You can use COBRA insurance for up to 18 months after termination of employment.
Individual coverage is available through health exchanges as part of The Affordable Care Act. There is an open enrollment period in November and December, but you do have the option of choosing a plan at any time within 60 days of your last day of employment. You can get detailed information and apply for coverage at Healthcare.gov. Monthly premiums vary greatly according to deductibles, copays and the type of health insurance you require. Subsidies are available for lower income adults. An important benefit of coverage through The Affordable Care Act is that preventive and wellness care is covered at 100% with no deductible. Because you can get colonoscopies, mammograms and physicals at no cost, ACA coverage makes perfect sense to get you through to age 65.
If you have an immediate need for healthcare and you don’t have insurance, check into community clinics available through non-profit or government agencies. Your health is the most important asset you have, and maintaining it should always be a priority. Just ask Dan Sykes. He didn’t think that waiting would be an issue. Medicare was able to help Dan through surgery and chemotherapy. He just celebrated his 70th birthday, but Dan still wonders how his life might have been different if he had the cough looked at sooner.
*Dan is a real cancer survivor, but his name was changed for this piece.
Center for Medicare and Medicare Services. Fast Facts. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts. Accessed 07/26/2021.
Patel DC, He H, Berry MF, et al. Cancer diagnoses and survival rise as 65-year-olds become Medicare-eligible. Cancer. 2021;127(13):2302-2310.