Inflation has eased nationwide in recent months, but older Black Americans — particularly those in rural areas — are still struggling to pay for their essential needs, often choosing between life-saving medications and rent. 

Even before the pandemic, half of adults who were 65 or older and lived alone didn’t have enough money to afford basic necessities. Older Black Americans are far more likely to experience economic insecurity than their white counterparts — 64% vs. 47%, according to the American Society on Aging. Though urban and rural communities have experienced similar rates of inflation, the pandemic especially exacerbated financial challenges for folks in rural areas, a region plagued with limited access to health care, transportation, and affordable housing, said Aisha Williams of the Center for Benefits Access at the National Council on Aging, a nonprofit organization that advocates for services and resources for older Americans. 

The financial hardships sometimes start before age 65, because people don’t yet qualify for Medicare yet, and pile on debt they cannot afford to pay, said Laura Harker, senior policy analyst at the Center on Budget and Policy Priorities. And the rising costs have caused some seniors to stretch or skip their medications altogether. Seniors are a “forgotten population,” said Johnola Morales, chief of staff and senior vice president of case management and home care services for the Osceola Council on Aging — a nonprofit organization that provides social services to seniors and families in Osceola County, Florida — and more conversations should be had about the quality of life for the end of life.

“Some of their quality of life is so poor, they don’t want to disturb anyone, but things are so inflated they can’t really live the quality of life they have,” Morales said. “If they have Social Security, it’s not increasing to match what’s going on. How are they paying for rent? Feeding themselves?”

Seniors should soon see some financial relief with the enactment of the Inflation Reduction Act. Signed into law by President Joe Biden in August, the act includes several health care-related policies, such as allowing Medicare to negotiate prescription drug costs with manufacturers and capping out-of-pocket costs for prescriptions. The law also extended Affordable Care Act subsidies that were set to expire in 2022, which means health care coverage will be more affordable for a longer period of time. 

We spoke to Williams, senior director of economic security and benefits at NCOA’s Center for Benefits Access, about how older Americans could benefit from the new federal policies. This transcript has been lightly edited for length and clarity.

Capital B: The Inflation Reduction Act included policies meant to help make health care more affordable. Can you talk about what these changes mean for Black elders who have been struggling with costs before, during, and after the pandemic?

Aisha Williams: There’s some things that will happen in the immediate future. When you combine those changes [from the Inflation Reduction Act] with changes to the Low Income Subsidy Program, also known as LIS and Extra Help, that will further reduce out-of-pocket costs for Medicare beneficiaries who are between 135% and 150% of poverty level, beginning in 2024. 

Aisha Williams

This occurs in a couple of ways. Partial subsidies will be replaced with full subsidies, which especially helps Black and brown beneficiaries. There will be no insurance premium for beneficiaries that are enrolled in benchmark plans. There’ll be no deductible, and then there’ll be lower co-payments. It also expands eligibility for full subsidies, and increases asset eligibility thresholds. What does that mean? More people will qualify for assistance.

What are other things older folks can expect?

Some things that seniors should be on the lookout for would include new limits on drug price increases, on caps on insulin costs. We talked about being able to afford healthy, nutritious food and how that impacts the prevalence of diabetes and related complications. Well, being able to cap insulin costs, beginning in 2023, will go a long way toward positively affecting that. Other things: Zero cost sharing for vaccines is really, really important, and then zero co-insurance for catastrophic costs, and that will also be combined with the reduced cap for out-of-pocket cost sharing. There’s just really a lot of meat on the bone in terms of what the Inflation Reduction Act can do to help seniors.

Another challenge facing seniors is accessing, enrolling and understanding their benefits. How does the National Council on Aging help?

NCOA really works at the nexus of health and wealth and wants to make sure that people can age with dignity, and with everything that they need, without it being an issue about who was lucky enough to be born with a certain set of circumstances or demographic profile. With the Center for Benefits Access, we partner with numerous community-based organizations, called Benefits Enrollment Centers, that directly help consumers understand what they may be eligible for, both related to health care costs as well as those things that affect social determinants of health, such as food security and our SNAP program. That’s one type of approach that we take to helping seniors access the resources they need. 

We also provide quite a bit of technical assistance to community-based organizations and government agencies. In this case, state health insurance programs known as CHIPS, those are the entities that really do specifically help seniors with Medicare enrollment and some limited set of other programs related to social determinants of health. We are the entity that is responsible for technical assistance around certain aspects of those programs. We also have really great tools, things such as, which can help folks to learn what money or resources they may be leaving on the table to the tune of $16 billion annually, because people don’t know what it is that they’re eligible for. 

As we start 2023, are there policies the organization is advocating for? 

The reality is that it really does take quite a bit of money to age well and with stability in the U.S. One of the things that we advocate for is the Elder Index, which shows the true cost of living in old age and in the U.S. It does a much better job at that than, like, federal poverty level statistics. When you use the Elder Index to look at the poverty data by race and ethnicity, it shows that 60% of Black women will age into poverty and 76% of Latinos. I think that it really helps to uncover more detailed information about the true costs of aging in America. 

Some of the things that we wished had been done that the [Inflation Reduction Act] didn’t include provisions to improve staffing and access to [Medicaid] Home and Community Based Services. It’s really great that things are more affordable. But it is true that in vulnerable communities — especially Black and brown communities, but all communities for that matter — home and community based services and direct care workforce professionals play an essential part of connecting people and helping them to use those resources to age well. Unfortunately, the bill didn’t include those types of provisions, but we are still very much working on those angles as well. 

Aallyah Wright is Capital B's rural issues reporter. Twitter @aallyahpatrice