Older Adults—Cost Pressure, Access, and Missed Screenings

Andres Jimenez MD MSED MBA MS

“A five-minute call now can prevent a missed mammogram or colonoscopy later. With seniors under cost pressure, the clinic’s job is to reduce friction and prove care quickly.” Dr. Andres Jimenez, Double-Board-Certified in Public Health & Prevention and Clinical Informatics, Founder of HealthPrevent360

KFF’s analysis underscores the stakes for older adults as OBBB rolls out: provisions could reduce Medicaid enrollment and access for people ages 50+, and Marketplace changes are expected to increase the uninsured among 50–64-year-olds. KFF summarizes: collectively, provisions “could affect the 22 million people ages 50 and older with coverage under the Medicaid program by reducing the number of people with Medicaid and reducing access to health and long-term care services.” KFF

KFF also notes that without extended enhanced premium tax credits, many 55–64 Marketplace enrollees face higher premiums in 2026, with a cited estimate of ~18% premium increases. The result? Some seniors may delay or skip needed screenings and follow-ups. KFF

Clinic actions that move the needle

• Proactive outreach to 50–64 cohort. Book CRC/BCS/CCS before benefits reset.

• Bundle visits and documentation. Wherever possible, coordinate labs, vitals, and referrals together.

• Rapid ingestion of outside results. Attach mammograms/colonoscopies within days to secure credit.

• Track social risks. Food, transport, and caregiver strain often shadow coverage and adherence.

Enrollments and red tapeKFF highlights that pausing streamlining rules can raise out-of-pocket costs for low-income seniors; even those who remain enrolled may face higher administrative friction. KFF

How HP360 can help

HP360 auto-ingests outside reports and produces payer-safe evidence packets, so your staff spends less time chasing and more time closing. Schedule a quick consult to see automated ingestion in practice.