The Availability of Care for Late-Middle-Aged Adults With Chronic ...

Access to appropriate health care is critical on many levels. Three include (a) primary prevention to maintain overall health, (b) accessibility to treatment for acute episodes in order to protect against negative chronic outcomes, and (c) assistance with maintenance of chronic conditions to prevent further decline or secondary conditions. But while health insurance is key to both health maintenance and rehabilitation, individuals in late middle age are at high risk for lacking any type of insurance (Pol et al., 2000). Medicare, which covers the cost of certain home health services and durable medical equipment, begins at age 65. Part A coverage is available to some who are disabled prior to the age of 65, although many in need do not pass strict eligibility criteria. In order to receive Medicare benefits prior to age 65, an individual must be eligible to receive and have received social security disability benefits for 24 months. This requires that she or he has worked at least 20 of the last 40 quarters, and is now judged to be so limited that she or he cannot work for at least the next year (Centers for Medicare and Medicaid Services [CMS], n.d.; Moon, 1996). Medicaid is only available to individuals in late middle age who meet both strict financial and disability criteria, and benefits vary considerably by state (Iezonni, 2003).

Given that most middle-aged adults, even those with functional limitations, do not meet both financial and disability criteria, private health insurance is the dominant source of insurance for this group. Private insurance covers little in terms of chronic care needs and is often dependent upon one’s (or one’s spouse’s) continued presence in the workforce. Not surprisingly, working-aged adults with functional limitations are less likely than those without to have any form of private health insurance (LaPlante, 1993; McCarty & Levine, 1999).