Medicare is the federal program that provides health coverage to over 66 million people ages 65 and older and younger people with long-term disabilities. More than half of all people with Medicare are women, including more than 31 million ages 65 and older and about 4 million under age 65 with long-term disabilities. Medicare plays a key role in supporting the health and well-being of women, covering a broad range of services essential to women’s health, including preventive, reproductive, primary, and specialty care, and prescription drugs.

This brief presents 10 key facts about women with Medicare, based on data from various sources (see methods for additional information). (A separate KFF brief, Coverage of Sexual and Reproductive Health Services in Medicare, describes Medicare coverage of services for women of reproductive age.) The language used here attempts to be as inclusive as possible, but the analysis draws on survey data that uses specific gender labels for female and male for the data year used for this analysis, not inclusive of gender non-binary, transgender and other gender expansive identities. In addition, due to sample size and data collection limitations, analysis is unavailable by race and ethnicity for Asian adults, American Indian and Alaska Native adults, and Native Hawaiian and Pacific Islander adults.

1. More Than Half of All People with Medicare Are Women, a Proportion That Rises with Age

In 2021, more than half (55%) of all Medicare beneficiaries were women and 45% were men (Figure 1). Of the more than 35 million women with Medicare, about 4 million are under age 65 with long-term disabilities (11%) and 4.3 million are ages 85 and older (12%). Since women live longer than men, on average (having 19.7 years of life expectancy at age 65 vs. 17 for men in 2021), women represent a larger share of older age cohorts. For example, nearly two-thirds (63%) of Medicare beneficiaries ages 85 and older are women.

2. Among Women with Medicare, Beneficiaries Under Age 65 with Disabilities Are More Likely to be Black and Hispanic Than Women in Older Age Groups

Reflecting the demographics of older residents of the U.S., White people are the largest racial/ethnic group among people with Medicare, both men and women, while Black and Hispanic people together represent approximately 2 in 10 beneficiaries. Among women with Medicare, Black and Hispanic women represent larger shares of those under age 65 – who qualify for Medicare due to having a long-term disability – than of women ages 65 and older (Figure 2). People on Medicare who are under age 65 with disabilities report worse access to care, more cost concerns, and lower satisfaction.

3. Women with Medicare Are More Likely to Live Alone or in a Facility Than Men; the Same is True for Women Ages 85 and Older Compared to Younger Women

Among Medicare beneficiaries, women are more likely than men to live alone, which may pose challenges as they grow older and are at greater likelihood of needing long-term care services and supports (LTSS). More than one-third of all women with Medicare (36%) live alone, rising to more than half (53%) of all women ages 85 and older (Figure 3). Women ages 85 and older are also considerably more likely than women ages 65 to 84 to live in facility (11% vs. 1%), including nursing homes, assisted living facilities, and other long-term care facilities. Medicare offers only time-limited coverage for skilled nursing facility services (up to 100 days) and does not typically cover long-term care services and supports needed by people who are unable to care for themselves in the community. (Medicaid is the primary payer of LTSS in the U.S., covering 20% of women with Medicare in 2021, as described below.)

4. Women Are More Likely Than Men to Be Enrolled in Medicare Advantage, and Among Women, Medicare Advantage Enrollment Rates Are Higher for Dual-Eligible Individuals and Women Who Are Black or Hispanic

Medicare beneficiaries can choose to get their Medicare benefits through the traditional Medicare program or a private Medicare Advantage plan. Many Medicare beneficiaries also have some type of additional coverage, which can help with Medicare cost-sharing requirements and, in some instances, provides benefits not otherwise covered by Medicare. This includes Medicaid, the federal-state health insurance program for people with low-incomes and modest assets.

In 2021, 49% of women covered by Medicare were enrolled in Medicare Advantage plans, a significantly higher share than men (46%) (Figure 4). (The share of all eligible Medicare beneficiaries enrolled in Medicare Advantage has increased since then and now exceeds 50% of all eligible beneficiaries.) Larger shares of Black and Hispanic women with Medicare were enrolled in Medicare Advantage in 2021 than White women (68%, 63%, and 44%, respectively).

In 2021, 20% of women with Medicare were also enrolled in Medicaid. Women under 65 were enrolled in Medicaid at over three times the rate of women ages 65 and older (59% vs. 16%); Black (47%) and Hispanic (48%) women with Medicare were also significantly more likely to have Medicaid than White women (13%). Having supplemental Medicaid coverage gives women financial assistance in paying their Medicare deductibles and cost sharing, whether they receive their Medicare coverage through traditional Medicare or a Medicare Advantage plan. In addition, they qualify for coverage of long-term services and supports under Medicaid than can provide support for care in a facility or community-based at home supportive care to assist with a range of health and functional needs.

5. Per Capita Income Is Lower for Women with Medicare Than Men, Declines with Age, and Is Substantially Lower for Black and Hispanic Women Than White Women

Overall, women with Medicare have lower per capita incomes than men. This is largely due to the fact that average Social Security income and pension benefits are lower for women than men, primarily because women generally have lower-paying jobs than men during their working years and because many worked part-time or left the workforce for periods of time to raise families or care for aging family members. For example, the average annual Social Security benefit was substantially lower for women than men ages 65 and older in 2021 – $14,204 and $18,101, respectively.

KFF analysis shows that in 2023, half of all women with Medicare had per capita income of $33,750 or less, which is about $5,000 lower than median per capita income for men with Medicare ($38,950) (Figure 5). Among those ages 65 and older, median income declines with age, from $38,150 for women ages 65 to 74 to $25,850 for women 85 and older. Median income is also substantially lower for Black and Hispanic women compared to White women; half of all Black women with Medicare had per capita incomes of $25,500 or less, and half of all Hispanic women with Medicare had per capita incomes of $18,750 or less in 2023, compared to median per capita income of $38,250 for White women.

6. Per Capita Savings Are Lower for Women Than Men, and Black and Hispanic Women with Medicare Have Substantially Lower Savings Than White Women

As with income, savings are also much lower for women with Medicare compared to men, with half of all women having per capita savings of $90,850 or less compared to $120,450 for men (Figure 6). Among women with Medicare, both the youngest and the oldest age cohorts have substantially lower per capita savings than women ages 65 to 74 ($131,100, compared to $40,900 for those under age 65 and $31,850 for those ages 85 and older).

Median per capita savings are much lower for Black and Hispanic women than White women with Medicare. Half of all Black women have $19,300 or less in savings, which is 7 times lower than that of White women in 2023. Half of all Hispanic women have savings of $16,350 or less, which is nearly 9 times lower than that of White women. Differences in income and savings among Black and Hispanic women compared to White men and White women reflect the cumulative impact of differences in education, job opportunities, access to retirement benefits and inherited wealth. Women overall are also slightly more likely to have no savings or to be in debt compared to men (11% vs. 9%).

7. More Than Half of Women with Medicare Under Age 65 and Ages 85 and Older Have a Functional Impairment; These Women Experience Higher Rates of Cognitive Impairment and Fair/Poor Health Status Compared to Women of Other Ages

Reflecting the fact that for people under age 65, eligibility for Medicare is based on having a long-term disability, women with Medicare under age 65 experience considerably higher rates of functional and cognitive impairment and poorer health status than their older counterparts on Medicare. Half of those under age 65 have a cognitive impairment, over three times the rate of women ages 65 and older (14%) (Figure 7). Women under age 65 are also more likely to have a functional impairment (56%) than women ages 65 and older (26%). Women under age 65 report fair or poor health (52%) at over three times the rate of women ages 65 and older (16%) and are more likely to have 5 or more chronic conditions (24%) compared to older women (17%).

Measures of overall health, cognitive, and functional status also reflect the poorer health status of women in the oldest age cohort relative to other older women. More than half of women ages 85 and older have a functional impairment (54%), nearly double the rate among women ages 65 to 84 (23%). Nearly one-third of women ages 85 and older have a cognitive impairment (30%) compared to 11% of women ages 65 to 84. Women ages 85 and older are also significantly more likely than women ages 65 to 84 to be in fair or poor health (20% vs. 16%) and have 5 or more chronic conditions (24% vs. 16%).

A significantly higher share of women than men have a functional impairment including limitations in activities of daily living (30% of women vs. 25% of men) and have five or more chronic health conditions (18% vs. 15%) (Appendix Table 1). Similar shares of women and men have a cognitive impairment (18% vs. 16%), and report being in fair or poor health (20% for both groups).

8. Black and Hispanic Women with Medicare Report Poorer Health Status and Have Higher Rates of Cognitive and Functional Impairments Than White Women

Black and Hispanic women with Medicare are significantly more likely than White women with Medicare to fare worse along certain measures of health status. For example, nearly four in ten (38%) Black and Hispanic women have a functional impairment compared to less than three in ten (27%) White women; 26% of Hispanic women and 21% of Black women have a cognitive compared to 16% of White women (Figure 8). Additionally, 36% of Hispanic women and 27% of Black women report being in fair or poor health compared to 18% of White women.

9. Among Women with Medicare, Heart Disease, Alzheimer’s/Dementia, and Incontinence Are More Common Among Those Ages 85 and Older; Depression, Lung Disease, and Diabetes Are More Common Among Those Under Age 65

Health conditions of women enrolled in Medicare differ by age cohort (Figure 9, Appendix Table 1). Women ages 85 and older are significantly more likely than women ages 65 to 84 to have heart disease (41% vs. 25%), Alzheimer’s/dementia (17% vs. 3%), and urinary incontinence (53% vs. 34%). Women under 65 are significantly more likely than women 65 and older to have depression (63% vs. 27%), diabetes (37% vs. 29%) and pulmonary disease (33% vs. 19%).

Women with Medicare overall experience higher rates of certain health conditions compared to men; for example, urinary incontinence (37% vs. 18%), depression (31% vs. 21%), osteoporosis (29% vs. 7%), and pulmonary disease (20% vs. 16%) (Appendix Table 1). Conversely, a larger share of men than women with Medicare had heart disease (35% vs. 26%) and diabetes (33% vs. 30%).

10. A Similar Share of Women and Men with Medicare Report Health Care Cost Problems; Among Women, They Are Most Commonly Reported by Those Who Are Low-Income, Under Age 65, or in Fair or Poor Health

Gaps in benefits, cost-sharing requirements, and premiums for Medicare and supplemental coverage can lead to cost-related challenges for some people with Medicare, including trouble getting care due to cost or money, delay in care due to cost, or problems paying medical bills. In 2021, a similar share of women and men with Medicare (12% vs 10%, respectively) reported that they faced at least one or more of these cost-related problems (Figure 10; data for men not shown). A higher share of women under age 65 (29%), Black (19%) and Hispanic (13%) women, women in fair or poor health (24%), and women with incomes below $20,000 (20%) reported experiencing more cost-related challenges than their counterparts.

Data are a cornerstone for efforts to advance health equity. How we ask for, analyze, and report information on race and ethnicity affects our ability to understand the racial and ethnic composition of our nation’s population and our ability to identify and address racial disparities in health and health care. The accuracy and precision of such data have important implications for identifying needs and directing resources and efforts to address those needs.

On March 29, 2024, the Office of Management and Budget (OMB) announced revisions to Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, which apply to federal data collection and reporting. The revisions include using a single combined question for race and ethnicity, adding Middle Eastern or North African (MENA) as a minimum category, clarifying instructions for individuals to select multiple racial and ethnic categories that represent their identity, and requiring collection of more detail beyond the minimum categories. In addition, the Standards require that data tabulation procedures result in the production of as much information on race and/or ethnicity as possible, including data for people reporting multiple racial and/or ethnic categories.

The updated standards are effective for all new federal racial and ethnic data collection and reporting as of March 28, 2024, and existing racial and ethnic data must be updated as soon as possible but no later than March 28, 2029. OMB indicates that these revisions are intended to result in more accurate and useful race and ethnicity data across the federal government and are the first revisions that have been made since the last directive was issued in 1997. This brief provides an overview of these changes and their implications.

Why Were the Standards Revised?

Data and research show that a growing number of people do not identify with the previously used OMB race and ethnicity categories. These standards were last updated in 1997, with subsequent guidance provided by the Department of Health and Human Services (HHS) in 2011, which called for additional granularity in the collection and reporting of racial and ethnic data where possible for surveys conducted by HHS. The diversity of the U.S. population has grown significantly since the standards were last updated in 1997, as the share of people identifying as multiracial has increased and immigration patterns have evolved. Research suggests that under the previous standards, some people with Hispanic ethnicity and people from the Middle East and North Africa  selected other race because they did not identify with the available categories. Moreover, recent refinements to how the Census and other national surveys ask about race and ethnicity within the previous standards resulted in increased measures of population diversity, largely due to increases in the shares of people reported as some other race or multiracial, particularly among the Hispanic population.

Specifically, data from the American Community Survey show that between 2010 and 2022, the share of people identifying as some other race grew from 5% to 7%, while the share reporting two or more races increased from 3% to 13% (Figure 1). Among the Hispanic population, the share who identified as some other race grew from 28% to 35% between 2010 and 2022, and there was a ten-fold jump in the share reporting as multiracial, from 4% to 43%. During this period, the share of Hispanic people identifying as White plummeted from 64% to 17%. The Census Bureau indicates that many of these differences were largely due to changes in the design, data processing, and coding of the race and ethnicity questions over this period (including write-in responses), highlighting the powerful impact of these decisions. The process changes also make it challenging to identify how much of the observed change is due to actual demographic shifts.

What was the Process for Updating these Standards?

In June 2022, OMB established a Federal Interagency Technical Working Group on Race and Ethnicity Standards to review the racial and ethnic data collection and reporting standards with a goal of updating them to better reflect the diversity of the nation. At that time, there were growing calls among federal, state, and local health agencies; health systems; health information technology experts, and commercial health insurance plans to revisit and revise the standards. The Working Group developed initial proposals and questions, which were published in a Federal Register notice in January 2023 to provide the opportunity for public input. In developing the new standards, the Working Group examined existing research and evidence, reviewed public comments submitted in response to the notice, and conducted listening sessions and town halls with stakeholders and members of the public. Based on this process, the Working Group outlined final recommendations to OMB, which informed OMB’s final decisions.

How Have the Standards Been Revised?

In March 2024, OMB announced revisions to the Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity that reflect the recommendations of the Working Group. Examples of how race and/or ethnicity data would be collected under these new standards are included in Appendix A. Key changes from the previous standards include:

• Moving to a single combined race and ethnicity question. Under the previous standards, there were separate questions for individuals to identify race and Hispanic or Latino ethnicity. Research suggests that having separate questions for race and ethnicity confused some respondents who may not view the two concepts as distinct. Studies have found that many Hispanic or Latino individuals view their Hispanic or Latino identity as their race and do not identify with the race categories provided in a separate question. Many commenters expressed that moving to a single race and ethnicity question would help provide a more accurate count of the Hispanic or Latino population by reducing the number of blank responses or those classified as “some other race.” In the 2020 Census, four in ten (44%) individuals who selected Hispanic or Latino as their ethnicity did not report a race or were classified as some other race. Some commenters expressed concern that a combined race and ethnicity question may contribute to a loss of data for Afro-Latino individuals, as respondents may solely select Hispanic or Latino. However, Census Bureau research did not find that use of a single combined question led to a significant difference in estimates of the Afro-Latino population.
• Adding MENA as a new minimum category. Prior to the 2024 update, the “White” racial category included people with European, Middle Eastern, or North African origins. However, there have been longstanding calls by the MENA community and the public to provide MENA as a separate category since most people of Middle Eastern or North African origin do not view themselves as White. Consistent with these perspectives, prior research shows a significant reduction in the share of people reporting some other race and White when a separate MENA category is offered compared to when there is no separate MENA category.
• Requiring detailed collection of racial and ethnic categories as the default. Under the revisions, agencies are required to collect the detailed categories outlined in the standards by default. These detailed categories represent the largest population groups within the broader minimum racial and/or ethnic categories. An agency may request an exemption to the requirement to collect more detailed data if it determines that the potential benefit would not justify the additional burden to the agency and the public or the additional risk to privacy or confidentiality. Under the prior standards, detailed racial and ethnic data collection was encouraged but not required. Overall, the majority of commenters supported the collection of more detailed data beyond the minimum categories as a default, citing the diverse experiences of groups within the broader categories and the importance of having detailed data to measure differences in health care outcomes. Some commenters expressed concern regarding privacy risks, respondent burden, and the burden on agencies.
• Modifying question instructions to encourage respondents to select all categories that reflect their identity. Specifically, question instructions must explicitly state that respondents should, “Select all that apply.” In cases in which detailed categories are collected with write-in responses, instructions must further encourage respondents to enter additional details, with instructions to, “Select all that apply and enter additional details in the spaces below.”

The revisions also make updates to terminology including removing use of “majority” and “minority” terminology (except when statistically accurate or when legal requirements call for use of those terms) and removing “Other” from the “Native Hawaiian and Other Pacific Islander” category title. They also make some revisions to definitions for the categories, including but not limited to removing “Negro” from the Black or African American definition, replacing “Far East” with “Central or East Asia” in the Asian definition, and removing the phrase “who maintains tribal affiliation or community attachment” from the American Indian or Alaksa Native definition.

Consistent with recommendations from the Working Group, OMB refrained from establishing requirements regarding a specific order for presenting racial and/or ethnic categories, continuing to leave this to agencies’ discretion. It notes that agencies generally order the categories alphabetically or by population size and that future research may help inform the best approach for ordering response options.

What are the Standards for Presenting Data on Race and/or Ethnicity?

OMB further specifies that agencies must use procedures that result in the production of as much information on race and/or ethnicity as possible, including for people reporting multiple categories, while still maintaining data quality and privacy. It encourages agencies to use one of three approaches for presenting data, including:

• Alone or in combination. This approach groups all individuals belonging to a racial or ethnic group, whether alone or in combination with another racial or ethnic group. For example, an individual who reports their identity as both White and Black would be included in both the “White alone or in combination category” and the “Black alone or in combination” category.
• Most frequent multiple responses. Under this approach, information is reported for as many race and ethnicity combinations as possible. In addition to the seven minimum race and/or ethnicity categories alone, the agency would report data for all combinations of racial and ethnic groups (e.g., American Indian or Alaska Native and Hispanic or Latino) that meet sufficient response thresholds or are of specific interest.
• Combined Multiracial and/or Multiethnic category. This approach presents data for the seven minimum race and/or ethnicity categories and groups all other respondents who identify multiple race and/or ethnicity categories into a single Multiracial and/or Multiethnic category. Since this approach provides limited understanding of the diversity of the population, OMB indicates that agencies should use this approach in combination with one of the alternative approaches above to meet the overarching requirement to provide as much race and/or ethnicity information as possible, including for people who report more than one category.

Looking Ahead

The updated guidelines issued by OMB are effective for all new data collection that includes race and/or ethnicity questions as of March 28, 2024, and all existing data must be updated to the new standards “as soon as possible but, no later than March 28, 2029.” Each agency must develop an Action Plan on Race and Ethnicity Data within 18 months of the notice of the revised standards and make them publicly available upon submission to OMB.

Bridging challenges are expected as the implementation of these guidelines takes effect, with agencies expressing via public input the importance of “tools to support bridging” to compare race and ethnicity data collected under the 2024 guidelines and the 1997 guidelines. To address these concerns, the OMB Working Group has provided bridging guidelines for federal agencies. Some commenters have also expressed concern regarding the tabulation of different racial and/or ethnic categories including how to tabulate responses for individuals who select multiple race and ethnicity categories and whether Hispanic or Latino responses will be presented separately from other racial categories in civil rights reporting.

OMB has also identified areas of future research, which include, among others, how to encourage respondents to select multiple race and/or ethnicity categories by enhancing question design, how to collect high quality and useful data related to descent from people who were enslaved in the United States, the optimal order for presenting the minimum categories, and how to collect race and/or ethnicity data consistently across different languages. OMB also indicates it will establish an Interagency Committee on Race and Ethnicity Statistical Standards, that will undertake regular reviews of the standards on a ten-year cycle and provide an opportunity for public input. It also may conduct a review at any time outside of those regular review periods.

Appendix: Examples of Race and/or Ethnicity Questions Consistent with Revised OMB Standards

Source: Office of Management and Budget, Revisions to OMB’s Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity

Source: Office of Management and Budget, Revisions to OMB’s Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity

As the U.S population ages and becomes increasingly diverse, people of color are projected to comprise close to half the population of adults ages 65 and older by 2060. Consequently, the health-related experiences of older people of color will increasingly merit attention from policymakers and health care professionals to ensure that the health care system meets the needs of an aging and increasingly diverse population. KFF research has documented racial and ethnic disparities in health care that affect people of all ages, including access to care, use of services, outcomes, and experiences with unfair treatment while seeking health care. These differences are influenced by policies and practices rooted in racism and other forms of discrimination.

Medicare provides health insurance coverage to nearly all people ages 65 and older, helping to mitigate disparities in health care related to insurance coverage that impact people under age 65, but racial and ethnic disparities in health care persist along other dimensions among older adults. For example, among people on Medicare, who are predominantly ages 65 and older, Black and Hispanic adults are more likely than White adults to report relatively poor health, higher rates of chronic conditions such as hypertension, higher rates of hospital admissions, and greater likelihood of receiving care in the lowest-rated hospitals. Black and Hispanic older adults also have substantially lower incomes and savings than their White counterparts to draw on during retirement and higher poverty rates, reflecting fewer years of education, lower earnings in their working years, disparities in job opportunities, less access to pension and other retirement benefits, and far less inherited wealth.

This analysis highlights key findings about the health care experiences of people ages 65 and older based on KFF’s 2023 Survey on Racism, Discrimination, and Health. A previous report from the survey focused on the experiences of all adults more broadly, including those under age 65.

While older adults are generally less likely than younger adults to report being treated unfairly or with disrespect in health care settings, older Black adults report these experiences at higher rates compared to other older adults. Among adults ages 65 and older, about one in ten Black adults (11%) and one in twenty Hispanic and Asian adults (5% for both) say there was a time in the past three years when a health care provider or their staff treated them unfairly or with disrespect because of their race or ethnic background, compared to just 1% of older White adults. Taking into account unfair treatment based on other factors beyond race and ethnicity, about one in seven (15%) older Black adults report experiencing unfair or disrespectful treatment in the past 3 years compared to smaller shares of older White (7%), Hispanic (7%), and Asian (8%) adults.

Half of older Black adults, four in ten older Hispanic adults, and one-third of older Asian adults say they prepare for possible insults or feel they need to be very careful about their appearance to be treated fairly during health care visits. Vigilant behaviors, such as preparing for insults or considering one’s appearance, are sometimes adopted by people who experience discrimination as a means of protection from the threat of possible discrimination and to reduce exposure. Among adults ages 65 and over, about four in ten Black adults (43%) and one-third of Hispanic adults (36%) say they feel they must be very careful about their appearance at least some of the time in order to be treated fairly when they visit a doctor or health care provider, larger than the share of older White adults (21%) who say so.

Older Black adults are also more likely than older White adults to say they try to prepare for possible insults from health care providers or their staff at least some of the time (22% vs. 8%). Taken together, half of older Black adults, four in ten (39%) older Hispanic adults, and one-third (32%) of older Asian adults report adopting at least one of these vigilant behaviors at least some of the time during health care visits, as do one-quarter (25%) of older White adults.

Older Hispanic and Asian adults are less likely than older White adults to feel comfortable asking providers questions and to say their provider usually explains things well and involves them in decision-making, which may reflect higher rates of limited English proficiency among these groups. While majorities of older adults across racial and ethnic groups report overall positive experiences with health care providers, older Hispanic and Asian adults are somewhat less likely than older White adults to say their providers explained things in a way they could understand (85%, 83%, and 93%, respectively) and involved them in decision-making about their care (75%, 66%, and 87%, respectively) during most or all of their health care visits in the past three years.

In addition, smaller shares of older Hispanic (69%) and Asian (65%) adults compared with older White adults (79%) say they have felt “very comfortable” asking providers questions about their health or treatment during visits in the past three years. These differences may reflect differences in English proficiency between these populations, as about one-third of older Hispanic (35%) and Asian (33%) adults have limited English proficiency, meaning they speak English less than very well.¹  They may also reflect gaps in how health care providers tailor services to meet culturally and linguistically diverse populations.

Majorities of older Black, Hispanic, and Asian adults say fewer than half of their recent health care visits were with providers who shared their racial and ethnic background. Reflecting limited racial and ethnic diversity of the health care workforce, and consistent with patterns seen among the general population, almost two-thirds of older Black adults (63%) and more than half of older Hispanic (56%) and Asian adults (54%) say that fewer than half of their health care visits in the past 3 years were with a doctor or health care provider that shared their racial and ethnic background. By contrast, three-quarters (74%) of White adults ages 65 and older say that half or more of their health care visits in the past 3 years were with a racially concordant health care provider.

Older Black and Hispanic adults are more likely than older White adults to report problems paying for health care, reflecting that larger shares of them live in lower income households. Adults ages 65 and older are generally less likely than younger adults to report problems paying for health care, largely due to the fact that nearly all older adults have health insurance coverage through Medicare. Overall, about one in ten (9%) older adults say they or a family member had problems paying for health care in the past 12 months compared with almost three in ten (28%) adults under age 65. However, racial and ethnic disparities in health care affordability are evident among older adults. About one in six older Black adults (16%) and one in seven older Hispanic adults (14%) report problems paying for health care, higher than the share of older White adults (8%) who say so. About one in ten (11%) older Asian adults also report problems affording health care, a share that is not statistically different from White adults. These disparities at least partially reflect income differences between these populations. About half of older Black (50%), Hispanic (52%), and Asian adults (48%) report having household incomes under $40,000 compared with 29% of older White adults. By contrast, about a quarter of older Asian (25%) and White adults (24%) report incomes of at least $90,000, about twice the share among older Black (13%) and Hispanic adults (12%).

1. The survey was conducted in English, Spanish, Chinese, Korean, and Vietnamese. Results likely underrepresent limited English proficiency among those who speak another language. ↩︎

On April 11, 2024, Governor DeSantis signed House Bill 433 into law, set to go into effect on July 1, 2024. Among other actions, the legislation prevents city and county governments from requiring that employers, including government contractors, provide heat protections for outdoor workers outside of those required under state or federal law. These protections include requiring water breaks and other cooling measures for outdoor workers. The law also bans local governments from giving preference to employers based on their heat exposure policies. In response to the legislation, county commissioners in Miami-Dade withdrew their pending proposal to provide heat protections standards to outdoor workers in the county. Florida is the second state after Texas to enact a policy that prevents local ordinances from mandating certain heat protections, including water breaks. This analysis shows that the law could impact nearly 1.8 million¹  nonelderly adult outdoor workers in Florida, who are disproportionately Hispanic and noncitizen immigrant workers. It is based on KFF analysis of 2022 American Community Survey data.

In Florida, Hispanic and noncitizen immigrant workers make up disproportionate shares of outdoor workers who will be impacted by the law. Hispanic workers make up 40% of the nonelderly adult outdoor workforce compared with 30% of the total nonelderly adult workforce, and noncitizen immigrants make up nearly twice the share of outdoor workers compared to their share of the workforce (22% vs. 12%) (Figure 1). Among outdoor workers, these groups make up particularly large shares of workers in transportation, outdoor cleaning, construction, and agriculture (Appendix Figure 1).

These policies have been enacted amid a recent spike in the frequency, duration, and intensity of climate change-related heat waves within the U.S. that have resulted in wildfires, air pollution events, and record-breaking hot days. Last year, Florida experienced its hottest year on record since 1895, with surface temperatures reaching 177 degrees Fahrenheit in some locations. Last year, some hospital systems in Florida experienced large increases in heat-related illness emergency visits. In April 2024, the U.S. Department of Labor (DOL) cited a contractor in South Florida for a lack of heat exposure protections after a migrant farmworker died from heat-related injuries in 2023. It is likely that more heat-related deaths may have occurred as heat-related injuries and deaths are suspected to be vastly undercounted and research shows that extreme heat is associated with a higher all-cause mortality.

Outdoor workers are exposed to high temperatures and are disproportionately likely to suffer from heat-related illnesses and deaths, which also have economic impacts. Research studies have found that agriculture, forestry, fishing, hunting, and construction workers experience the highest rates of heat-related mortality. Without any mitigation strategies, the threats associated with exposure to extreme heat are expected to increase due to climate change. A 2021 study reports that by 2050 extreme heat-related labor productivity losses could cost Florida up to $52 billion. Further, another report finds that without mitigation, extreme heat could put $8.4 billion in total annual earnings at risk by 2065 for Florida’s outdoor workers. Black and Hispanic people and noncitizen immigrants are likely to be the most affected due to their overrepresentation in many outdoor occupations. Beyond increased risks of climate-related health risks due to their jobs, people of color, immigrants, and other underserved groups also face increased climate-related health risks due to structural inequities, such as higher rates of poverty and uninsured rates as well as immigration-related fears.

As of April 2024, six states (CA, CO, MN, NV, OR, and WA) have occupational heat protection standards for outdoor workers and Maryland is in the process of developing its own heat stress standard. MN and OR also have heat protections for indoor workers, and CA is in the process of developing heat protection standards for indoor workers. Last year, the federal government took steps to protect workers from extreme heat, including issuing the first hazard alert on heat and ramping up the DOL’s enforcement of heat safety violation inspections. The National Institute for Occupational Safety and Health has occupational heat stress prevention recommendations, including teaching workers how to recognize the signs and symptoms of heat-related illness and changing working conditions to reduce exposure to and health risks associated with heat. Additionally, The Occupational Safety and Health Administration (OSHA) has a general duty clause that requires employers to provide their employees with a place of employment that “is free from recognized hazards that are causing or likely to cause death or serious harm to employees,” which includes heat-related hazards. However, there currently are no federal worker heat protection standards in place. OSHA is in the process of developing federal level indoor and outdoor worker heat protection standards, but there is no information on when they will be completed.

As the country moves into the summer months and scientists estimate a one in three chance that 2024 will be hotter than 2023, efforts to increase awareness and understanding of the dangers associated with exposure to extreme heat will be important for reducing negative extreme heat-related health impacts. Continued actions to mitigate climate-related health risks for workers will be important as the effects of climate change continue to grow.

Appendix

1. KFF Analysis of 2022 American Community Survey 1-year Public Use Microdata Sample (PUMS) ↩︎

A new KFF analysis finds donor government funding for family planning efforts in low- and middle-income countries totaled US$1.35 billion in 2022, a decline of 9% (US$129 million) compared to 2021 ($1.48 billion). This figure marks the lowest level of funding since 2016 ($1.31 billion). While some of the decline was because of decreases in actual funding by most donor governments, more than two-thirds can be attributed to exchange rate fluctuations due to the strengthening of the U.S. dollar against most currencies during 2022. Funding from the United States wasn’t affected by the currency fluctuations.

Funding from six donor governments (Australia, Canada, Denmark, Germany, Sweden, and the U.K.) decreased in 2022, though the size of the decreases was significantly smaller when accounting for exchange rate fluctuations. Some of these declines were linked to budgetary pressures associated with the humanitarian response to the conflict in Ukraine, as cited by some donors. While funding from the United States remained flat, funding from the Netherlands and Norway increased.

Without standardizing funding levels to the size of donor economies, the United States remained the largest donor to family planning funding, providing 43% ($582.9 million) of total funding from donor governments, followed by the Netherlands ($217.4 million, 16%), the United Kingdom. ($174.7 million, 13%), Sweden ($121.3 million, 9%) and Canada ($88.3 million, 7%). However, when family planning funding is standardized by GDP, the Netherlands ranked first, followed by Sweden and the United Kingdom; the United States ranked 7th.

Most family planning funding is provided bilaterally (US$1.3 billion or 96%). The remaining 4% ($50 million) is for multilateral contributions to the United Nations Population Fund’s core resources, adjusted for an estimated share for family planning.

The results of this analysis will be included in the annual progress report from FP2030, Measurement Report 2024.  

In a new analysis, KFF finds that 3.6 million people with Medicare could be eligible for coverage of Wegovy (semaglutide) now that the Food and Drug Administration has approved the use of the anti-obesity drug to reduce the risk of heart attacks and stroke in certain patients.

This change potentially allows access to Wegovy for just over 1 in 4 of the 13.7 million people on Medicare diagnosed with obesity or overweight, based on data from 2020, the analysis shows.

Based on KFF research, about 7% of beneficiaries, or 3.6 million people, had established cardiovascular disease and obesity or overweight in 2020 and could be eligible for coverage of Wegovy to reduce the risk of serious heart problems. (Among this group, 1.9 million also had diabetes, making them already eligible for Medicare coverage of other GLP-1 drugs approved for diabetes.) 

Although Wegovy already had FDA approval as an anti-obesity medication, Medicare is prohibited by law from covering drugs when prescribed for obesity. The drug’s new approval by the FDA for use to reduce heart attacks and stroke paves the way for Medicare to cover it for those purposes.How this change affects Medicare spending will depend in part on how many Part D plans add coverage for Wegovy and the extent to which plans apply restrictions on use like prior authorization, how many eligible people use the drug, and negotiated prices paid by plans. Assuming just 10% of eligible beneficiaries use Wegovy in a given year, and assuming a 50% rebate on the list price, Medicare would incur nearly $3 billion in additional net Part D spending for one year for this one drug alone.KFF also finds that beneficiaries who take Wegovy could face monthly out-of-pocket costs of $325 to $430 if they have to pay a percentage of the drug’s $1,300 list price for a month’s supply. The new Part D cap on out-of-pocket spending would limit beneficiaries’ out-of-pocket cost to around $3,300 in 2024 and $2,000 in 2025—still significant sums for those who live on modest incomes. 

It is possible that Medicare could select semaglutide for drug price negotiation as early as 2025, based on its earliest FDA approval in late 2017, with a negotiated price available beginning in 2027. This could help to lower Medicare spending on Wegovy as well as Ozempic, the version approved for type 2 diabetes. (Both the Part D out-of-pocket spending cap and Medicare drug price negotiations were established under the Inflation Reduction Act of 2022.)

The full analysis, and other data and analyses about Medicare spending on prescription drugs, is available at kff.org.

The FDA recently approved a new use for Wegovy (semaglutide), the blockbuster anti-obesity drug, to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese. Wegovy belongs to a class of medications called GLP-1 (glucagon-like peptide-1) agonists that were initially approved to treat type 2 diabetes but are also highly effective anti-obesity drugs. The new FDA-approved indication for Wegovy paves the way for Medicare coverage of this drug and broader coverage by other insurers. Medicare is currently prohibited by law from covering Wegovy and other medications when used specifically for obesity. However, semaglutide is covered by Medicare as a treatment for diabetes, branded as Ozempic.

What does the FDA’s decision mean for Medicare coverage of Wegovy?

The FDA’s decision opens the door to Medicare coverage of Wegovy, which was first approved by the FDA as an anti-obesity medication. Soon after the FDA’s approval of the new use for Wegovy, the Centers for Medicare & Medicaid Services (CMS) issued a memo indicating that Medicare Part D plans can add Wegovy to their formularies now that it has a medically-accepted indication that is not specifically excluded from Medicare coverage. Because Wegovy is a self-administered injectable drug, coverage will be provided under Part D, Medicare’s outpatient drug benefit offered by private stand-alone drug plans and Medicare Advantage plans, not Part B, which covers physician-administered drugs.

How many Medicare beneficiaries could be eligible for coverage of Wegovy for its new use?

The new use of Wegovy is targeted to people with established cardiovascular disease – meaning a prior heart attack, prior stroke, or peripheral arterial disease – and either obesity or overweight. Based on KFF analysis of Medicare data from 2020, an estimated 7% of Medicare beneficiaries, or 3.6 million overall, had established cardiovascular disease and obesity or overweight in 2020, and so could be eligible for Medicare coverage of Wegovy for its new indication (Figure 1) (see Methods for details). This number may well be higher based on more current data than were available for this analysis. These 3.6 million beneficiaries represent just over a quarter (26%) of the 13.7 million Medicare beneficiaries diagnosed as being overweight or obese in 2020. This means that the FDA’s approval of the new use for Wegovy potentially opens up access to this drug for 1 in 4 people on Medicare with obesity or overweight.

Of these 3.6 million beneficiaries, 1.9 million also had diabetes (other than Type 1) and may already have been eligible for Medicare coverage of GLP-1s as diabetes treatments prior to the FDA’s approval of the new use of Wegovy.

Not all people who are eligible based on the new indication are likely to take Wegovy, however. Some might be dissuaded by the potential side effects and adverse reactions. Out-of-pocket costs could also be a barrier. Based on the list price of $1,300 per month (not including rebates or other discounts negotiated by pharmacy benefit managers), Wegovy could be covered as a specialty tier drug, where Part D plans are allowed to charge coinsurance of 25% to 33%. Because coinsurance amounts are pegged to the list price, Medicare beneficiaries required to pay coinsurance could face monthly costs of $325 to $430 before they reach the new cap on annual out-of-pocket drug spending established by the Inflation Reduction Act – around $3,300 in 2024, based on brand drugs only, and $2,000 in 2025. But even paying $2,000 out of pocket would still be beyond the reach of many people with Medicare who live on modest incomes. Ultimately, how much beneficiaries pay out of pocket will depend on Part D plan coverage and formulary tier placement of Wegovy.

Further, some people may have difficulty accessing Wegovy if Part D plans apply prior authorization and step therapy tools to manage costs and ensure appropriate use. These factors could have a dampening effect on use by Medicare beneficiaries, even among the target population.

When will Medicare Part D plans begin covering Wegovy?

Some Part D plans have already announced that they will begin covering Wegovy this year, although it is not yet clear how widespread coverage will be in 2024. While Medicare drug plans can add new drugs to their formularies during the year to reflect new approvals and expanded indications, plans are not required to cover every new drug that comes to market. Part D plans are required to cover at least two drugs in each category or class and all or substantially all drugs in six protected classes. However, facing a relatively high price and potentially large patient population for Wegovy, many Part D plans might be reluctant to expand coverage now, since they can’t adjust their premiums mid-year to account for higher costs associated with use of this drug. So, broader coverage in 2025 could be more likely.

How might expanded coverage of Wegovy affect Medicare spending?

The impact on Medicare spending associated with expanded coverage of Wegovy will depend in part on how many Part D plans add coverage for it and the extent to which plans apply restrictions on use like prior authorization; how many people who qualify to take the drug use it; and negotiated prices paid by plans. For example, if plans receive a 50% rebate on the list price of $1,300 per month (or $15,600 per year), that could mean annual net costs per person around $7,800. If 10% of the target population (an estimated 360,000 people) uses Wegovy for a full year, that would amount to additional net Medicare Part D spending of $2.8 billion for one year for this one drug alone.

It’s possible that Medicare could select semaglutide for drug price negotiation as early as 2025, based on the earliest FDA approval of Ozempic in late 2017. For small-molecule drugs like semaglutide, at least seven years must have passed from its FDA approval date to be eligible for selection, and for drugs with multiple FDA approvals, CMS will use the earliest approval date to make this determination. If semaglutide is selected for negotiation next year, a negotiated price would be available beginning in 2027. This could help to lower Medicare and out-of-pocket spending on semaglutide products, including Wegovy as well as Ozempic and Rybelsus, the oral formulation approved for type 2 diabetes. As of 2022, gross Medicare spending on Ozempic alone placed it sixth among the 10 top-selling drugs in Medicare Part D, with annual gross spending of $4.6 billion, based on KFF analysis. This estimate does not include rebates, which Medicare’s actuaries estimated to be 31.5% overall in 2022 but could be as high as 69% for Ozempic, according to one estimate.

What does this mean for Medicare coverage of anti-obesity drugs?

For now, use of GLP-1s specifically for obesity continues to be excluded from Medicare coverage by law. But the FDA’s decision signals a turning point for broader Medicare coverage of GLP-1s since Wegovy can now be used to reduce the risk of heart attack and stroke by people with cardiovascular disease and obesity or overweight, and not only as an anti-obesity drug. And more pathways to Medicare coverage could open up if these drugs gain FDA approval for other uses. For example, Eli Lilly has just reported clinical trial results showing the benefits of its GLP-1, Zepbound (tirzepatide), in reducing the occurrence of sleep apnea events among people with obesity or overweight. Lilly reportedly plans to seek FDA approval for this use and if approved, the drug would be the first pharmaceutical treatment on the market for sleep apnea.

If more Medicare beneficiaries with obesity or overweight gain access to GLP-1s based on other approved uses for these medications, that could reduce the cost of proposed legislation to lift the statutory prohibition on Medicare coverage of anti-obesity drugs. This is because the Congressional Budget Office (CBO), Congress’s official scorekeeper for proposed legislation, would incorporate the cost of coverage for these other uses into its baseline estimates for Medicare spending, which means that the incremental cost of changing the law to allow Medicare coverage for anti-obesity drugs would be lower than it would be without FDA’s approval of these drugs for other uses. Ultimately how widely Medicare Part D coverage of GLP-1s expands could have far-reaching effects on people with obesity and on Medicare spending.