Older Coloradans Were Healthy, Medicare Access Was a Major Factor

Among Coloradans 65 and older, 95% were covered by public health insurance programs.

September 20, 2024

September 23, 2024

Coloradans are staying healthy as they age and defying outdated notions of what aging looks like. Analysis from the 2023 Colorado Health Access Survey (CHAS ) shows that Coloradans 65 and older reported that they are nearly as healthy as adults ages 18 to 64. Almost all have health insurance, because they are eligible for Medicare. Compared with younger Colorado adults, more visited a health care provider in the past year and fewer experienced barriers to health care. The combination of greater coverage and fewer barriers for older Coloradans likely contributed to their health.

Statewide, Coloradans 65 and older make up more than a sixth (18.4%) of adults. In many regions, such as southeast Colorado, it's more than one in four.

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While Colorado’s older adults were more likely to be white than younger adults (84.6% of 65+, compared to 65.6% of ages 18-64), a little more than one in 10 (15.4%) were Black, Hispanic/Latino, or some other race, and 6.6% spoke a language other than English at home.

In 2023, 95.0% of adults 65 and over were covered by publicly funded insurance, including Medicare and Medicaid. About 4.5% were covered by private insurance (employer-sponsored or individual) or another insurance type. In contrast, less than a third of adults ages 18-64 were covered by public insurance (28.8%), a majority of whom got their coverage through Medicaid. And 6.2% of adults ages 18-64 were uninsured.

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Older Coloradans Report Good Health

Despite prevailing stereotypes about health and aging, Coloradans across generations report similar levels of good general health. More than eight in 10 (81.4%) Coloradans 65 and older said they were in excellent, very good, or good health.

In addition to overall health, older adults reported high rates of good mental health, defined by this survey as fewer than eight days in the past month of stress, depression, or problems with emotions. Among Coloradans 65 and older, a majority (89.9%) said they had good mental health compared with younger adults (67.4% for ages 18-64).

While this is promising news for older Coloradans, reporting mental good health and having good mental health are not the same. Older people grew up in a time when talking about mental health was taboo. They may not consider depression or anxiety related to their mental health. And, they also may feel more stigma about mental health problems or asking for help.

Similarly, older Coloradans may dismiss feelings of anxiety or depression and changes in their general health as a normal part of aging. The CHAS cannot gauge whether older Coloradans’ report better health based on their own expectations of what their health should be for their age. They may report very good or excellent health, because they’re comparing their current health to an internally held stereotype.

Older Adults Reported Similar General Health (81.4%) as Younger Adults (82.3%)

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Older Coloradans Experienced Fewer Barriers to Care

Use of Care

A higher percentage of Coloradans 65 and older visited their doctors compared with younger Coloradans, likely because when they had a health concern, they had the insurance to get the care they needed. About nine in 10 adults in this age group (91.1%) visited a doctor during the previous 12 months, compared with 77.8% of the younger group. More than seven in 10 (71.3%) older adults sought care from a specialist compared with 49.6% of 18-to-64-year-olds.

Older adults used telemedicine almost as much as younger ones (37.8% compared with 39.7%). The COVID-19 pandemic made telemedicine more available and appealing to older Coloradans. Medicare also took steps to cover telehealth services, making them financially viable for providers. More recent legislation made some of those changes permanent and extended others through 2024.

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Typical Barriers to Care

Having insurance does not mean that all health care services are affordable, but public insurance does seem to reduce the cost burden for older Coloradans. Five times as many adults ages 18-64 (15.4%) did not visit the doctor for needed care due to cost, compared with adults 65 and over (2.9%).

One in five (19.2%) adults ages 18-64 did not get specialty care due to cost, compared with fewer than one in 20 adults in the 65+ group (4.9%). And twice as many younger Coloradans reported trouble filling a prescription due to cost (14.7% of 18- to 64-year-olds) compared with older adults (6.1%).

Compared with barriers for younger adults, Coloradans 65 and older had substantially fewer issues accessing care. The ability of Coloradans to get an appointment as soon as they thought one was needed was less of an issue for older adults (20.8%) than for younger ones (32.9%). Coloradans over 65 and older were told less often that the doctor’s office or clinic was not accepting new patients (6.3% compared with 13.4% for 18-64). And older Coloradans were seldom told by providers that they did not accept their type of insurance (4.2% for 65+ compared with 13.4% for 18-64).

While older adults experience fewer barriers to care compared to younger Coloradans, many face challenges using their benefits. Insurance coverage and benefits are confusing, and public insurance plans are no exception. A 2023 KFF study showed that 51% of adults insured through Medicare and 58% of adults insured with Medicaid experienced a problem using their health insurance in the past 12 months. These problems included insurance covering less for care than expected, provider network issues, difficulty receiving preauthorization for needed care, prescription drug coverage, and others. Helping older adults better understand their Medicare and Medicaid benefits could encourage members to use their benefits.

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Older adults were less likely than younger adults to report needing culturally competent care to meet their health care needs (5.2% compared with 15.1%). However, this still represents nearly 41,000 older adults who reported that they had some characteristic — such as their language, race, religion, culture, gender identity, among others — that affects the kind of care that they need.

Older Coloradans Still Face Challenges

Coloradans 65 and older reported that physical, mental, or emotional conditions limited their daily activities at about the same rate as younger generations (19.1% compared with 16.0% for 18- to 64-year-olds). Rates did differ, though, for Colorado’s oldest adults. By age 79, about a third of Coloradans (30.2%) reported limited daily activities. Even so, two in three Coloradans in that age group said they had no difficulty performing daily activities. Either they are not experiencing those challenges, or they believe they are managing them well on their own or with the help of loved ones.

The percentage of Coloradans reporting housing and food insecurity decreased with age, but still represented a large number of people. Many older Coloradans live on fixed incomes, so increases in food or housing costs quickly become a concern. Among Coloradans 65 and older, 2.2% worried they would not have stable housing in the next two months (compared with 9.4% in the 18-64 group) and 4.5% ate less than they felt they should because they could not afford food (compared with 14.9% in the 18-64 group).

Implications

One in five Coloradans — about 1.3 million people — will be over the age of 65 by 2035. But that shouldn’t scare us. Access to Medicare and Medicaid programs in Colorado makes a difference to the health of older Coloradans and reduces their barriers to getting care.

But obstacles still exist. Policymakers should continue to look for ways to keep the cost of care down, especially for prescription drugs, which would help Coloradans regardless of age.

Health care systems have an opportunity to improve their ability to provide culturally responsive care by diversifying their workforce. And insurance providers should consider a variety of ways to help their patients and members understand the benefits they provide.

Medicare vs Medicaid: What’s the Difference?

Medicare

While both Medicare and Medicaid are government-funded insurance programs, the federal government manages Medicare, and its benefits are the same across the country. Medicare eligibility is primarily based on age (65+), although people of any age with certain disabilities and diagnoses also qualify.

The term Original Medicare refers to Medicare Part A (hospital coverage) and Part B (medical services), with the option to add Part D (prescription drugs). Medicare Advantage Plans (Part C) are offered by private insurance companies that have been approved by Medicare. They cover the services offered under Part A, Part B, and often Part D. Costs, benefits, and providers vary by plan. In 2024, 54% of those who are Medicare eligible nationally chose Medicare Advantage plans over Original Medicare. Learn more about the differences.

Medicaid

Medicaid eligibility is primarily based on having a low household income, though people at any income can qualify under specific circumstances. States administer Medicaid based on federal guidelines. Each state determines its plan’s specific eligibility and benefits, so coverage and costs vary. In Colorado, Medicaid is called Health First Colorado and is managed by the Colorado Department of Health Care Policy and Financing.

Medicaid covers some services that Medicare either does not cover or doesn’t cover completely. This includes long-term services and supports, which many older adults use. Older adults with qualifying incomes can enroll in both Medicare and Medicaid (dually eligible). When this is the case, Medicaid often picks up the costs not paid by Medicare.