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As the U.S population ages and becomes increasingly diverse, people of color are projected to comprise close to half the population of adults ages 65 and older by 2060. Consequently, the health-related experiences of older people of color will increasingly merit attention from policymakers and health care professionals to ensure that the health care system meets the needs of an aging and increasingly diverse population. KFF research has documented racial and ethnic disparities in health care that affect people of all ages, including access to care, use of services, outcomes, and experiences with unfair treatment while seeking health care. These differences are influenced by policies and practices rooted in racism and other forms of discrimination.
Medicare provides health insurance coverage to nearly all people ages 65 and older, helping to mitigate disparities in health care related to insurance coverage that impact people under age 65, but racial and ethnic disparities in health care persist along other dimensions among older adults. For example, among people on Medicare, who are predominantly ages 65 and older, Black and Hispanic adults are more likely than White adults to report relatively poor health, higher rates of chronic conditions such as hypertension, higher rates of hospital admissions, and greater likelihood of receiving care in the lowest-rated hospitals. Black and Hispanic older adults also have substantially lower incomes and savings than their White counterparts to draw on during retirement and higher poverty rates, reflecting fewer years of education, lower earnings in their working years, disparities in job opportunities, less access to pension and other retirement benefits, and far less inherited wealth.
This analysis highlights key findings about the health care experiences of people ages 65 and older based on KFF’s 2023 Survey on Racism, Discrimination, and Health. A previous report from the survey focused on the experiences of all adults more broadly, including those under age 65.
While older adults are generally less likely than younger adults to report being treated unfairly or with disrespect in health care settings, older Black adults report these experiences at higher rates compared to other older adults. Among adults ages 65 and older, about one in ten Black adults (11%) and one in twenty Hispanic and Asian adults (5% for both) say there was a time in the past three years when a health care provider or their staff treated them unfairly or with disrespect because of their race or ethnic background, compared to just 1% of older White adults. Taking into account unfair treatment based on other factors beyond race and ethnicity, about one in seven (15%) older Black adults report experiencing unfair or disrespectful treatment in the past 3 years compared to smaller shares of older White (7%), Hispanic (7%), and Asian (8%) adults.
Half of older Black adults, four in ten older Hispanic adults, and one-third of older Asian adults say they prepare for possible insults or feel they need to be very careful about their appearance to be treated fairly during health care visits. Vigilant behaviors, such as preparing for insults or considering one’s appearance, are sometimes adopted by people who experience discrimination as a means of protection from the threat of possible discrimination and to reduce exposure. Among adults ages 65 and over, about four in ten Black adults (43%) and one-third of Hispanic adults (36%) say they feel they must be very careful about their appearance at least some of the time in order to be treated fairly when they visit a doctor or health care provider, larger than the share of older White adults (21%) who say so.
Older Black adults are also more likely than older White adults to say they try to prepare for possible insults from health care providers or their staff at least some of the time (22% vs. 8%). Taken together, half of older Black adults, four in ten (39%) older Hispanic adults, and one-third (32%) of older Asian adults report adopting at least one of these vigilant behaviors at least some of the time during health care visits, as do one-quarter (25%) of older White adults.
Older Hispanic and Asian adults are less likely than older White adults to feel comfortable asking providers questions and to say their provider usually explains things well and involves them in decision-making, which may reflect higher rates of limited English proficiency among these groups. While majorities of older adults across racial and ethnic groups report overall positive experiences with health care providers, older Hispanic and Asian adults are somewhat less likely than older White adults to say their providers explained things in a way they could understand (85%, 83%, and 93%, respectively) and involved them in decision-making about their care (75%, 66%, and 87%, respectively) during most or all of their health care visits in the past three years.
In addition, smaller shares of older Hispanic (69%) and Asian (65%) adults compared with older White adults (79%) say they have felt “very comfortable” asking providers questions about their health or treatment during visits in the past three years. These differences may reflect differences in English proficiency between these populations, as about one-third of older Hispanic (35%) and Asian (33%) adults have limited English proficiency, meaning they speak English less than very well. They may also reflect gaps in how health care providers tailor services to meet culturally and linguistically diverse populations.
Majorities of older Black, Hispanic, and Asian adults say fewer than half of their recent health care visits were with providers who shared their racial and ethnic background. Reflecting limited racial and ethnic diversity of the health care workforce, and consistent with patterns seen among the general population, almost two-thirds of older Black adults (63%) and more than half of older Hispanic (56%) and Asian adults (54%) say that fewer than half of their health care visits in the past 3 years were with a doctor or health care provider that shared their racial and ethnic background. By contrast, three-quarters (74%) of White adults ages 65 and older say that half or more of their health care visits in the past 3 years were with a racially concordant health care provider.
Older Black and Hispanic adults are more likely than older White adults to report problems paying for health care, reflecting that larger shares of them live in lower income households. Adults ages 65 and older are generally less likely than younger adults to report problems paying for health care, largely due to the fact that nearly all older adults have health insurance coverage through Medicare. Overall, about one in ten (9%) older adults say they or a family member had problems paying for health care in the past 12 months compared with almost three in ten (28%) adults under age 65. However, racial and ethnic disparities in health care affordability are evident among older adults. About one in six older Black adults (16%) and one in seven older Hispanic adults (14%) report problems paying for health care, higher than the share of older White adults (8%) who say so. About one in ten (11%) older Asian adults also report problems affording health care, a share that is not statistically different from White adults. These disparities at least partially reflect income differences between these populations. About half of older Black (50%), Hispanic (52%), and Asian adults (48%) report having household incomes under $40,000 compared with 29% of older White adults. By contrast, about a quarter of older Asian (25%) and White adults (24%) report incomes of at least $90,000, about twice the share among older Black (13%) and Hispanic adults (12%).
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