TABLE 10-2 Health Care Coverage for Persons 65 Years of Age and Over, 1998 (in percent)

Insurance Type




Private insurance




Private, work-based








Medicare only





SOURCE: Data from National Center for Health Statistics (2001).

Table 10-2 shows the level of health care coverage for black, white, and Hispanic older adults (National Center for Health Statistics, 2001). Almost all of these persons have Medicare. However, in comparison with whites, black and Hispanic older adults are considerably less likely to have private insurance and more likely to receive Medicaid or to have Medicare as their only insurance.

The limitations of Medicare create economic challenges for blacks and Hispanics. Medicare does not cover such medical needs as prescription drugs, dental care, and long-term care, and it imposes various out-of-pocket medical expenses: an annual deductible for some care, copayments on physician charges, and payment for one day of inpatient care. These expenses may represent a substantial burden for low-income older adults, and minorities are more affected because of lower household incomes. In 1996, two-thirds of white Medicare beneficiaries had incomes of less than $25,000; 90 percent of black and Hispanic beneficiaries had incomes this low (Gornick, 2000). Other data show that black and Hispanic older adults have higher rates of poverty than their white counterparts, as do Asians and American Indians and Alaska Natives (Williams and Wilson, 2001).

Many older adults reduce their out-of-pocket expenses by purchasing supplemental private insurance, but black and Hispanic older adults are a little more than twice as likely as whites not to do so (Wallace et al., 1998). Not surprisingly, although black Medicare beneficiaries report higher levels of morbidity than their white counterparts, they report lower levels of office visits and more inpatient, emergency room, and nursing home visits (Gornick, 2000). In comparison with whites, black beneficiaries also have markedly fewer visits to specialists, and they receive such diagnostic services as mammography and sigmoidoscopy much less often (Gornick, 2000). For some older persons with low incomes and limited assets, Medicaid can cover much of their out-of-pocket medical expenses. However, only about 11 percent of older Medicare beneficiaries also receive Medicaid; these dual eligibles are more likely to be in poor health and over age 85 than other Medicare beneficiaries (Feder et al., 2001).

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