Racial and Ethnic Health Inequities and Medicare
By 2060, People of Color Will Comprise Close to Half of the U.S Population Ages 65 and Older
The population of the United States ages 65 and older is projected to grow from 56 million in 2020 to 95 million in 2060, accounting for nearly a quarter of the nation’s total population in 2060.
The U.S population ages 65 and over is also expected to become more diverse over time. Between 2020 and 2060, White adults are projected to account for a decreasing share of adults ages 65 and older, with their population declining from 76% to 55%, while the share of adults ages 65 and older who are people of color is projected to nearly double, from 25% to 47%. Much of this increase reflects growth in the older Hispanic adult population, with the share of adults ages 65 and older who are Hispanic projected to more than double over the next four decades, from 9% in 2020 to 21% in 2060 (Figure 1).
The Average Number of Years of Life Remaining at Age 65 Is Substantially Lower for Black Adults Than for White or Hispanic Adults
In 2018, adults in the U.S who reached age 65 were expected to live an additional 19.5 years on average –reflecting a 5-year gain in life expectancy since 1960, prior to the enactment of Medicare.1
However, life expectancy at age 65 is lower among Black adults (18 years) than among White adults (19.4 years) and Hispanic adults (21.4 years) (Figure 2). Among adults in all three groups, life expectancy at age 65 is higher for women than men.
Notably, Hispanic male and female adults have the highest life expectancy at age 65, despite being socioeconomically disadvantaged compared to White adults. Research has, in part, attributed this advantage (i.e., “Hispanic paradox”2) to lower smoking rates and other positive health behaviors among Hispanic adults relative to other groups, as well as immigration-related processes that indirectly select healthier immigrants.3 However, these findings are still not fully understood. Researchers have also projected that among Hispanic adults born in the United States, this life expectancy advantage is expected to diminish due to increasing prevalence of obesity.4
The Majority of Medicare Beneficiaries Are White Adults, While 24% Are People of Color
In 2018, there were 60.9 million Medicare beneficiaries in total, including adults ages 65 and older and younger adults living with a long-term disability. A majority of Medicare beneficiaries are White, while 24% are people of color. This includes 10% (6 million) Black beneficiaries, 8% (5.1 million) Hispanic beneficiaries, and 6% (3.7 million) beneficiaries in other racial and ethnic groups, including Asian, Native Hawaiian or Other Pacific Islander, and American Indian or Alaska Native people as well as people identifying two or more races (Figure 3).
Compared to the Racial/Ethnic Distribution of Medicare Beneficiaries at the National Level, Black and Hispanic Beneficiaries Account for a Disproportionate Share of the Medicare Population in Some States
While the Medicare population in all states is predominantly White, Black and Hispanic beneficiaries account for a disproportionate share of the Medicare population in some states, relative to the racial/ethnic distribution of Medicare beneficiaries at the national level (Table 1, Figure 4). Black adults account for 11% of the Medicare population nationally, but a larger share in 14 states and the District of Columbia, and less than 5% in 22 states. Notably, the share of Black adults in the Medicare population in the District of Columbia (63%) is nearly six times higher than the national average (Table 1). Hispanic adults account for 8% of the Medicare population nationally, but a larger share in nine states, and less than 5% in 35 states and the District of Columbia. In large part, these distributions of Medicare beneficiaries by race and ethnicity reflect the variation in the racial and ethnic composition of the U.S population across states.
Compared to White Medicare Beneficiaries, Black Beneficiaries Are Less Likely to Be Married and More Likely to Live Alone
Household living arrangements of Medicare beneficiaries differ by race and ethnicity. Researchers have considered living alone as a potential predisposing factor for social isolation, which is a risk factor for poor health outcomes.5
Compared to White beneficiaries, Black beneficiaries are more likely to live alone (54% versus 33%, respectively) (Figure 5). Conversely, smaller shares of Black and Hispanic beneficiaries are married than White beneficiaries (35%, 47%, and 54%, respectively), with Black and Hispanic beneficiaries being less likely to be living with just their spouse compared to White beneficiaries.
Larger Shares of Black and Hispanic Medicare Beneficiaries Are Under Age 65 and Living with a Long-Term Disability Compared to White Beneficiaries
The vast majority (86%) of Medicare beneficiaries are ages 65 and older, while 14% are under age 65 and qualify for Medicare due to a long-term disability.
Larger shares of Black (25%) and Hispanic (19%) beneficiaries are under age 65 compared to White beneficiaries (12%) (Figure 6). Beneficiaries under age 65 are more likely than older adults to have lower incomes, report fair or poor health status, and have a cognitive or mental impairment, regardless of race/ethnicity.