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Healthcare costs can be a significant burden on seniors. Individuals age 65 and older spend 2 to 3 times more on health care than people in their 20s and 30s, due largely to higher healthcare needs and escalating medical costs. In addition, senior housing can be expensive and may require a high income to qualify for subsidized living programs.

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To explore these issues, we examined data from the ACA-related Health and Retirement Study (HRS). We used interrupted time-series analyses to compare outcomes in middle age between those exposed to the ACA’s coverage expansions and their counterparts who did not experience them. Our main explanatory variable was a person’s age at Medicare eligibility.

Our results showed that exposure to the ACA’s coverage expansions led to modest reductions in out-of-pocket costs and improvements in health for adults who reached Medicare eligibility at age 65. These changes were partly driven by the elimination of the Medicare Part D “doughnut hole” that had previously led to large increases in out-of-pocket spending for some seniors.

However, despite the positive effects of the ACA, many seniors will still face challenges to affordability and access to affordable health coverage in retirement. This is especially true for individuals with lower incomes, as eligibility criteria for Medicaid are stringent and increase at age 65, leaving some without supplemental health insurance or assistance.