Characteristics: The proportion of the older population that is female has been increasing. In 1960 53% of the population age 65 and older were women, now the figure has grown to 60%. Among the "oldest old" (those 85 and older) nearly three‑quarters are women, and 80% of those women are widows. 

Increasingly older people live alone. One in ten Wisconsin households is an elderly person living alone. Older women are more likely than older men to live alone. Thirty‑nine percent of women 65 and older five alone while only 18% of the men do so. 

USE OF HEALTH SERVICES BY THOSE 65 AND OLDER  

Older people are heavy users of the health care system. In Wisconsin, most older people in the community report seeing a doctor in the past year (87% according to the Wisconsin Family Health Survey) and a third have seen a doctor 4 times or more during the year. Older people account for nearly a third of all hospitalizations and nearly 20% of older people spend at least one night in a hospital per year. 70% of home health clients are older people and 7% of the elderly use home health each year.[5] 90% of nursing home clients are age 65 or older and 47% are 85 or older.[6] According to the 1990 U.S. Census 31% of Wisconsinites age 85 and older are living in nursing homes.[7]

Paying for Health Care  

The elderly spend more in actual dollars and proportionately on health care than the nonelderly. Households under 65 spend 4% of their expenditures on health care versus 11 % for those 65 and older. Health care for people 65 and older as a whole is paid for from a variety of sources. Medicare pays for 45% of the nation's elderly health care costs, Medical Assistance (or Medicaid) pays for 12.6, other government funds pay for 6% and private sources pay for 37%.[8] 

Medicare has contributed greatly to the well‑being of Americans age 65 and older. It is funded and administered entirely by the federal government and is the major source of insurance for acute health care for the elderly. Services covered by Medicare include hospital services, doctor visits, and short term recuperative nursing home and home health care. Medicare does not cover prescription drug costs, hearing aids, glasses, dental care or long term care. Despite the substantial medical benefits under the Medicare system, due to the increased cost and intensity of services and therapies prescribed today, after adjusting for inflation elderly families now spend over 50% more on out of pocket health care costs than they did before the passage of Medicare.[9]

Medicaid provides comprehensive health insurance for people 85 or older who have very low incomes. The program is paid for partly by the federal government and partly by states. The state government administers Medicaid under federal regulations. Medicaid eligibility levels range a great deal across states. In most states (including Wisconsin) people who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid. Nationally about 70% of the Medicaid dollar for the elderly goes to pay for nursing home care; 8% each goes to pay for prescription drugs, home health, hospitals and other expenses and only 1% goes to physicians. This is because Medicare pays physician costs first and Medicaid pays for costs not covered by Medicare.[10] 

Supplemental Private Insurance to augment Medicare has become an important funder of elderly health care. Nationally in 1990 over 75% of Medicare enrollees had private insurance that supplemented Medicare coverage. The price range for these Wedigap policies was $300 to $2,000 per year, depending on the level of coverage.[11] 

Other out‑of‑pocket health care costs: The costs of prescription medications, which can be unpredictable and are not covered by Medicare, are a growing economic burden for older people. The Age Profile of Older Wisconsin Residents, a telephone survey of people 60 and older living in the community[12], found that in the previous month people spent an average of $42 on out of pocket prescription drug costs.[13] This adds up to an average of over $500 in out of pocket costs per person per year. Dental care is also not covered under Medicare. National data from 1987 found that on average people 65 and older spent $92 a year on dental care.[14]  

ELDERLY ECONOMICS  

Income: We can learn about the income of older Wisconsinites from two sources: the 1990 U.S. Census of the population and the Age Profile of Older Wisconsin Residents. By and large Medicare beneficiaries have modest incomes. According to the census, in 1989 29% of households where the household head was overage 65 had incomes under $10,000. Only 7% of Wisconsin's elderly households reported incomes over $50,000 in 1989. 

Assets: According to the Age Profile Survey, in Wisconsin in 1989 only 13% of single women, 21 % of single men and 25% of couples age 65 and older reported liquid assets over $60,000. Many older people may be income‑eligible for economic aid but have too many assets to qualify. A single person is not eligible for Medicaid if he or she has over $2,000 in liquid assets, a couple may not have more than $3,000. 50% of impoverished single people age 65 and older report liquid assets of over $2,000. Fifty‑seven percent of older couples in poverty report a figure over $5,000.[15] 

 Poverty: Great strides have been made in reducing poverty among the elderly over the past 20 years. In 1970 22% of people 65 and older were in poverty. In 1990 9% of those age 65 plus had incomes below the census poverty threshold. Another 8% of those age 65 plus had incomes between 100% and 125% of this level. The federal poverty thresholds for 1995 are $623 in monthly income for single people and $836 for couples. (The thresholds are updated annually usually in February.) 

When combining the information about the health care costs of people 65 and older with information on their economic well‑being, it is important to recognize that the population 65 and older is a varied group. Poverty increases with age among those 65 and older and is more likely among women and minorities: 

-      13% of those age 75 and older have incomes below the poverty line and 11 % have incomes between 100% and 125.6 of the poverty level. In other words about a quarter of the 75+ age group have incomes below 125% of the federal poverty threshold.

-        Women are twice as likely to be in poverty as men (12% vs.t3%).

-        One fourth of minority elderly are in poverty and 10% have incomes between 100 and 125% of the poverty level.

ENDNOTES