multigeneration portraitThis article is one in a series of stories about how people across the country are using the Elder Index to understand the true cost of living for older adults and its economic implications. If you know someone who would like to receive information about these stories, send us a note at

By Taryn Hojlo

Medicare is an important resource for millions of older Americans, but that benefit isn’t free and it certainly doesn’t eliminate all other healthcare expenses elders face.

In Washington State, more than a million people were enrolled for Medicare benefits in 2018 and that number has been climbing, as it has across the country as the United States continues to grow older. Some of those people have found Medicare a particular economic challenge.

Northwest Health Law Advocates, a non-profit organization based in Seattle, is focused on older Washington residents who saw some existing healthcare-related benefits eliminated once they enrolled in Medicare. Recently, it has been using the University of Massachusetts Boston’s Elder Index to supplement research and advocacy work around the issue.

“We call it the Medicare cliff,” said Ann Vining, a staff attorney at the organization that has been advocating for affordable, quality health care for all Washington residents since 1999. “If you’re in some relatively lower income brackets, you have some access to some subsidies that you lose when you go onto Medicare.”

For example, the Medicaid expansion group adopted by Washington and other states under the Affordable Care Act makes benefits available to adults with incomes below 138 percent of the Federal Poverty Level. Expansion group rules place no restrictions on eligibility based on other assets owned by beneficiaries.

But that Medicaid program is no longer available to beneficiaries once they turn 65 and become eligible for Medicare. Those expansion group members can then apply for the long-standing Medicaid program covering aged, blind or disable people. But at that point, incomes must be much lower to qualify and strict asset-ownership limits apply to Medicaid eligibility.

“Medicare is not free, and assistance programs available to Medicare recipients have far less generous eligibility limits,” said Vining. “This is why getting Medicare can be a ‘cliff’ in which people with low or moderate income who gain Medicare lose access to assistance they need to make Medicare affordable.”

Higher basic living expenses, particularly those for housing, can make Medicare and other health costs even less affordable for some older Washington residents. Vining is using the Elder Index to drive that point home, emphasizing the economic squeeze that can vary in different parts of the state.

The index, developed and managed at UMass Boston, is a free online tool that provides realistic and detailed cost of living data for older adults living in every U.S. county.

“Housing is a big divider, as the index reflects,” said Vining. “It has a huge impact on the money people need for basic expenses. The health assistance programs, like Medicaid, do not take into account the very high housing costs we have in some parts of Washington State.”

To raise awareness of that issue among potential stakeholders, NoHLA advocates have been developing a variety of resources, such as specialized reports and presentations, to help communities play an active role in finding solutions. The Elder Index has proven to be a useful tool for enhancing the effectiveness of these resources by providing detailed economic data at the county level.

Earlier this year, Vining put that feature to use while developing a presentation for King and Snohomish counties, two of the most densely populated areas in the state. According to the Elder Index, housing costs in these counties account for an exceptionally large share of total living expenses.

A single, older adult in good health and renting a home King County can expect to pay $2,831 in monthly no-frills living expenses, according to Elder Index data. Most of that expense is the cost of  housing, an estimated $1,588 a month. King, the nation’s 12th most populous county, is home to Seattle.

In neighboring Snohomish County, a similar situation is at work. Estimated total living elder expenses are slightly lower there, at $2,807 per month. But housing costs are the same as those in King County.

Vining wanted to show community members from both counties how their housing expenses could make Medicare even less affordable for some elders. But after hosting a few presentations, she found many attendees reporting that they still didn’t understand the relationship.

So Vining and her colleagues decided to supplement their presentations with Elder Index figures that had previously been included in an additional written report. Although she and her team are still reviewing the new presentation, she hopes it will become even more effective in educating stakeholders.

“We are not very far into our project,” she said, “but slowly we are working to get greater understanding of the issues and the options to expand eligibility for health care cost assistance.”