Health insurance became available to more Americans in 2014 following reforms to the Affordable Healthcare Act (ACA) that expanded Medicaid and introduced subsidies and cost-sharing for insurance plans available through the Marketplace.

These reforms resulted in better access to care and better health outcomes among adults under 50. But what about middle-aged and senior (65 years old and older) adults? How did the coverage and cost improvements granted by ACA reforms affect them?

When middle-aged people can afford health insurance, they are more likely to get regular preventive care, rather than wait until health issues that have been neglected become more serious problems.

Researchers at the University of Michigan recently investigated health outcomes, out-of-pocket costs and health care use among seniors who became eligible for Medicare after the ACA reforms took effect.

They found that adults aged 65 to 68 years old had fewer out-of-pocket costs, less use of medications for chronic diseases and fewer hospitalizations than those who became eligible before the reforms were implemented. In fact, in the years after these healthcare reforms went into effect, people in their first few years of eligibility for Medicare spent about $417 less out of pocket than before the ACA changes were implemented.

The availability of more affordable health insurance options can change how people age into Medicare, Renuka Tipirneni, first author of the study, told TheDoctor.

It pays to take care of yourself in middle age, but sometimes people avoid it because they cannot afford health insurance. When middle-aged people can afford health insurance, Tipirneni explained, they are more likely to get regular preventive care, rather than wait until health issues that have been neglected become more serious problems.

People in their first few years of eligibility for Medicare spent about $417 less out of pocket than before the ACA changes were implemented.

The Michigan team reported that the improved health outcomes and lower out-of-pocket costs their study revealed were driven less by Medicaid expansion and more by the greater number of health plan options available. “If you can afford health insurance and have coverage options, it is [possible] to see your doctor regularly to be screened and receive treatment for any health conditions,” she said.

Medicare claims from more than 2,700 participants in the Health and Retirement Act who qualified for Medicaid or financial assistance with ACA coverage were included in the study. Over 75 percent of the sample identified as white; almost 58 percent had a high school education or less.

The study can be found in JAMA Health Forum.