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Risk of Large Medical Expenditures at Older Ages and Their Impact on Economic Well-being
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Risk of Large Medical Expenditures at Older Ages and Their Impact on Economic Well-being

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  • Susann Rohwedder

    (RAND)

  • Péter Hudomiet

    (RAND)

  • Michael D. Hurd

    (RAND)

Abstract

We study out-of-pocket (OOP) medical expenditure risk of the U.S. population ages 55 and older using data from the Health and Retirement Study and its supplemental survey on household spending. We document trends in individual-level OOP spending from 1998 to 2018, both at the median and 95th percentile, showing a large increase until 2004, followed by rapid declines, so that 2018 OOP was less than 1998 OOP spending. We show how these changes impacted the budget share of OOP as a fraction of total household spending and analyze how households adjust the composition of their spending as OOP expenses vary. Because the distribution of OOP expenses is skewed, households face a non-negligible risk of incurring a large expense. We examined the extent to which OOP medical expenditures contribute to economic hardship among older households, as measured by food insecurity and skipping medications because of cost. We found a weak relationship with respect to food insecurity, suggesting that government programs, like Medicaid, help protect against OOP risk leading to such as an extreme form of hardship. However, we obtained statistically significant and economically meaningful effects with respect to medication insecurity: An increase from the 10th to the 90th percentile in OOP spending would increase the probability of medication insecurity by about 15 percentage points. When asked about their perceived OOP risk, individuals tend to substantially overestimate the chances of large OOP spending, although less so at advanced ages; prior experience with OOP expenses seems to lead to more accurate expectations.

Suggested Citation

  • Susann Rohwedder & Péter Hudomiet & Michael D. Hurd, 2022. "Risk of Large Medical Expenditures at Older Ages and Their Impact on Economic Well-being," Working Papers wp457, University of Michigan, Michigan Retirement Research Center.
    • Handle: RePEc:mrr:papers:wp457
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    References listed on IDEAS

    as
    1. Margherita Borella & Mariacristina De Nardi & Eric French, 2018. "Who Receives Medicaid in Old Age? Rules and Reality," Fiscal Studies, John Wiley & Sons, vol. 39(1), pages 65-93, March.
    2. John Bailey Jones & Aaron Steelman, 2019. "Lifetime Medical Spending of Retirees," Richmond Fed Economic Brief, Federal Reserve Bank of Richmond, issue May.
    3. Susann Rohwedder & Michael D. Hurd & Péter Hudomiet, 2022. "Explanations for the Decline in Spending at Older Ages," Working Papers wp440, University of Michigan, Michigan Retirement Research Center.
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