She said it came completely out of left field; she thought she was healthy and very active. Before her diagnosis, everyone from her doctors to her insurance agent said she’d likely live longer than her mother, who died at age 94. But that’s no longer the case; pancreatic cancer is a “grim prognosis,” she said.
“At that point I thought, well, retirement is off the table because I need my income,” the Midwest-based Mary, whose last name and profession are known to BI but withheld over privacy concerns, said.
She realized she had to keep working to afford the costs of her treatment, like traveling out of state to see specialists. She decided to start drawing Social Security earlier than she anticipated to supplement her income. What she found, though, was that her benefits were reduced because, in a prior job, her employer paid into a pension and not into Social Security — even though Mary cashed out that pension.
“It was traumatic enough to deal with the cancer and the cancer diagnosis,” she said. “And then to realize that I had no one to fall back on — I have no other income to fall back on.”
Now, Mary is subsisting on her salary, Social Security, and a robust insurance plan through her workplace. If she retired, she’d have to switch to a Medicare insurance option. While the current iteration of the plan seems to potentially cover her treatments, she’d be out of luck if it ever changed — or came up against billing issues.
Many Americans are heading into what they expected to be their retirement years still working or just scraping by. Older Americans are also increasingly dealing with medical debt and financial instability in their later years. It’s yet another example of a new reality facing America’s would-be retirees: working until they can’t anymore.
“I used to say this all the time as a joke, I’m going to have to work until the day I die because I can’t possibly ever afford to retire,” Mary said. “And now it looks like I will be working until the day I die because I cannot afford to lose my job and my health insurance, as much as I would like to retire.”
Older Americans are racking up medical debt
Mary still feels fortunate — her ability to work from home and have insurance gives her peace of mind. She only finally got a “windfall” salary increase in the past few years, which has gone towards paying debt.
“I know there are so many people in my shoes who don’t have what I have,” she said.
Indeed, a report from the Consumer Financial Protection Bureau found that, as of 2020, adults 65 and older had $53.8 billion in unpaid medical bills — a 20% increase from 2019. On average, older adults had $13,800 in unpaid medical bills, even as they were going to the doctor less. That comes as many still have what the report calls “comprehensive medical insurance”; older Americans on Medicare and Medicaid are actually more likely to have unpaid bills. And Americans like Mary, who are still paying off debts like mortgages, are also more likely to have unpaid medical bills.
Even with Mary’s “incredible” health insurance, it took a little while to get everything straightened out with her coverage. She wasn’t sure how much the treatment would cost, so she started to tap into Social Security — but, because of her prior pension, her check was reduced by around $230 a month. While it may not sound like a lot of money, she said, it makes a difference. Currently, her check is around $1,800.
“My retirement plan right now is keep going until they tell me I have six months or less left to live,” she said. “And at that point, that’s when I’ll retire because it won’t matter anymore what health insurance plan I’m on. I’ll be on hospice; Medicare covers that. I won’t have to worry about bills.”
Making difficult choices
While Mary is terrified of losing her job — and the insurance that comes with it — she still stresses that she’s lucky to have both of those.
“I think of the people who are losing their homes or taking out second mortgages, unable to keep working, unable maybe even to keep their insurance,” she said. She said that she thinks all the time about how there must be a better way for the country to fund healthcare so people don’t have to end up making difficult choices.
One of her medications costs $3,000 a month; her health insurance brings that copay down to around $30 a month, and she knows some people have to pay $500 for that same drug. Mary said she needs that medication to be able to digest food.
“This has been eye-opening,” she said. “I don’t know that I could have ever understood the kinds of really difficult decisions seniors have to make in situations like this until I was confronted with it myself.”
And for Mary, that means anticipating that she won’t be able to retire. She has a “wonderful” support system and has accepted her disease.
“It’s the hand I’ve been dealt. It is what it is,” she said. But, that said, “I have plenty of, well-intentioned friends and family who keep saying to me, well, why didn’t you just retire? You might not have that much time left — which I don’t — and wouldn’t you like to just enjoy it?”
She always has the same response: “I can’t afford to; I literally cannot afford to give up my paycheck or my health insurance until I’m forced to.”
Are you a senior or would-be retiree facing a financial dilemma? Contact this reporter at jkaplan@businessinsider.com.
