Os sentidos do aposentar-se na visão de sujeitos aposentados / The senses of retirement in the perspective of retired subjects

O artigo tem o objetivo de investigar como se dá o processo de interrupção do trabalhar no momento da aposentadoria e como os sujeitos passam por essa experiência em um cenário em que o trabalho é considerado fundamental na vida das pessoas. Foi utilizada metodologia qualitativa, composta por análise de narrativa de entrevistas realizadas com 20 sujeitos aposentados. Os resultados da pesquisa evidenciam que o fator financeiro é bastante relevante, no entanto existem aspectos subjetivos que não são ponderados no momento de parar de trabalhar. De maneira complementar, percebeu-se que ficar sem trabalho em uma sociedade produtivista faz com que os sujeitos se sintam desconfortáveis, mesmo tendo o direito legitimado para o descanso. Eles dizem se sentir julgados como inúteis e improdutivos pela sociedade, o que torna o ócio penoso em muitos momentos. Por fim, as narrativas demonstraram que se aposentar é percebido como ficar velho e sem perspectiva de futuro

The article aims to investigate how retirement occurs and is perceived by subjects in a society in which work is seen as fundamental in people's lives. A qualitative approach was used and data were collected and analysed through interviews with 20 subjects and narrative analysis. Results show that finances is quite a relevant factor when choosing to retire, while subjective aspects to this process are disregarded. Complementarily, not working in a productivity-bound society makes subjects uncomfortable, despite their legitimized right to rest. The participants reported feeling judged as useless and unproductive by society, which makes idleness painful in many moments. Finally, the narrative analysis showed that retiring is perceived as getting old and having no perspective for the future

Wealth Management and Retirement.

SUMMARY: The purpose of this publication is to introduce basic financial planning concepts and highlight their use in creating a retirement savings plan. These tools may help young surgeons set their financial targets and create a plan to meet them, whereas surgeons later in their careers may reflect on their choices and implement adjustments, or be inspired to pass on the lessons they learned to the next generation. This publication is limited by design and should be thought of as a primer, not a comprehensive treatise. The topic of personal financial management is as vague as it is broad, and there are many concepts and situations that are outside the scope of this publication. Unique goals, income and expense streams, and risk tolerances necessitate individualized solutions, but there are fundamental concepts listed below that are more universally applicable. The discussion is tailored to the high income stream that plastic surgeons can expect, albeit one that starts relatively late in their careers compared to nonphysician colleagues. There are three foundational principles the reader should take away: having a plan is crucial in achieving any financial goal; starting any savings/investment endeavors as early as possible is as or more important than the amount of capital committed to them; and lastly, individual investors (professional and amateur) have consistently demonstrated an inability to consistently do better than the market over the long run.

Impact of Pain on Employment and Financial Outcomes Among Cancer Survivors.

PURPOSE: Although pain is a frequently reported symptom among individuals with cancer, there is limited information on the impact of pain on employment or financial outcomes. This study used nationally representative data to examine the role of pain levels on employment and financial outcomes. METHODS: We used data from the 2016-2017 Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement to identify 1,213 adults diagnosed with cancer. Multivariable logistic regression analyses were used to examine association of pain levels and self-reported employment and financial outcomes. RESULTS: Approximately 43% of adults with a cancer history reported no pain, 29% mild pain, 18% moderate pain, and 10% severe pain over the past 7 days. Compared with those reporting no pain, individuals reporting any pain had significantly increased likelihood of adverse employment outcomes including early retirement, feeling less productive, and staying at a job because of concerns about losing insurance. Individuals with any pain (compared with no pain) also had significantly increased likelihood of adverse financial outcomes including borrowing money or going into debt, inability to cover medical costs, and worrying about paying medical bills. For both employment and financial outcomes, there were dose-response relationships, with worse outcomes generally associated with greater pain levels. CONCLUSION: Pain is frequently associated with adverse employment and financial outcomes among cancer survivors, and greater pain is associated with worse outcomes. Better assessment of pain severity among survivors and implementation of strategies to assist with employment and financial objectives may be important steps to enhance patient-centered care.

Association of Food Insecurity With Allostatic Load Among Older Adults in the US.

Importance: Allostatic overload, a biomarker of wear and tear, could be the potential pathway through which food insecurity leads to increased morbidity risk. Objective: To assess the association of food insecurity with allostatic load (AL) among US adults aged 50 years or older. Design, Setting, and Participants: A multiwave longitudinal cohort study was conducted using data from the 2006 to 2014 waves of the Health and Retirement Study in a national cohort study setting. The data comprise 26 509 person-years observations from 14 394 noninstitutionalized individuals aged 50 years or older during the study period. Data were analyzed from September 1 to December 14, 2020. Exposures: Moderate food insecurity (not enough money to buy the food needed) and severe food insecurity (reduced food intake due to financial constraints) measured at the household level. Main Outcomes and Measures: The AL score (0-9, with higher scores indicating a greater risk of physiologic dysregulation) and binary indicators of dysregulated inflammatory (C-reactive protein), cardiovascular (systolic and diastolic blood pressure, pulse rate, and cystatin C), and metabolic (hemoglobin A1c, body mass index, waist-to-height ratio, total cholesterol to high-density lipoprotein cholesterol ratio) systems. Results: Of 14 394 participants included in the analysis, the median age was 60 (IQR, 56-69) years, 8143 (56.6%) were women, 517 (3.6%) were moderately food insecure, and 804 (5.6%) were severely food insecure. In adjusted models, the incidence rate of AL was 1.05 (95% CI, 1.00-1.09) times higher for the participants with moderate food insecurity and 1.11 (95% CI, 1.07-1.15) times higher for the participants with severe food insecurity, compared with those who were food secure. The increased incidence rate of AL among participants with severe food insecurity was associated with C-reactive protein level (odds ratio [OR], 1.22; 95% CI, 1.04-1.44), cystatin C level (OR, 1.23; 95% CI, 1.01-1.51), hemoglobin A1c level (OR, 1.27; 95% CI, 1.01-1.59), body mass index (OR, 1.84; 95% CI, 1.41-2.40), waist-to-height ratio (OR, 1.54; 95% CI, 1.26-1.88), and total to high-density lipoprotein cholesterol ratio (OR, 1.32; 95% CI, 1.10-1.59) inflated to the high-risk range. The interaction between moderate food insecurity and Supplemental Nutrition Assistance Program (SNAP) enrollment (ß = -0.18; P = .001) and the interaction between severe food insecurity and SNAP enrollment (ß = -0.09; P = .02) were associated with a reduction in AL. Conclusions and Relevance: In this national cohort study of US adults aged 50 years or older, food insecurity was associated with higher AL, mainly through dysregulation of the inflammatory and metabolic systems. SNAP enrollment may modify this association between food insecurity and AL.

Finance 101 for Physicians.

Although physicians enjoy extensive educational backgrounds, financial planning typically is not a significant component of the curricula they have completed. As a result, many physicians could benefit from greater financial acumen, and their preparation for retirement might be lacking in light of their relatively high-income levels. This article by a private wealth advisor with 29 years of industry experience provides physicians with the basic building blocks to understand and manage their finances. It focuses on 3 pillars of financial planning: (1) protecting themselves, their families, and their assets; (2) reducing their taxes; and (3) growing their wealth.

Association of diabetes type and chronic diabetes complications with early exit from the labour force: register-based study of people with diabetes in Finland.

AIMS/HYPOTHESIS: Diabetes and diabetes complications are a cause of substantial morbidity, resulting in early exits from the labour force and lost productivity. The aim of this study was to examine differences in early exits between people with type 1 and 2 diabetes and to assess the role of chronic diabetes complications on early exit. We also estimated the economic burden of lost productivity due to early exits. METHODS: People of working age (age 17-64) with diabetes in 1998-2011 in Finland were detected using national registers (Ntype 1 = 45,756, Ntype 2 = 299,931). For the open cohort, data on pensions and deaths, healthcare usage, medications and basic demographics were collected from the registers. The outcome of the study was early exit from the labour force defined as pension other than old age pension beginning before age 65, or death before age 65. We analysed the early exit outcome and its risk factors using the Kaplan-Meier method and extended Cox regression models. We fitted linear regression models to investigate the risk factors of lost working years and productivity costs among people with early exit. RESULTS: The difference in median age at early exit from the labour force between type 1 (54.0) and type 2 (58.3) diabetes groups was 4.3 years. The risk of early exit among people with type 1 diabetes increased faster after age 40 compared with people with type 2 diabetes. Each of the diabetes complications was associated with an increase in the hazard of early exit regardless of diabetes type compared with people without the complication, with eye-related complications as an exception. Diabetes complications partly but not completely explained the difference between diabetes types. The mean lost working years was 6.0 years greater in the type 1 diabetes group than in the type 2 diabetes group among people with early exit. Mean productivity costs of people with type 1 diabetes and early exit were found to be 1.4-fold greater compared with people with type 2 diabetes. The total productivity costs of incidences of early exits in the type 2 diabetes group were notably higher compared with the type 1 group during the time period (€14,400 million, €2800 million). CONCLUSIONS/INTERPRETATION: We found a marked difference in the patterns of risk of early exit between people with type 1 and type 2 diabetes. The difference was largest close to statutory retirement age. On average, exits in the type 1 diabetes group occurred at an earlier age and resulted in higher mean lost working years and mean productivity costs. The potential of prevention, timely diagnosis and management of diabetes is substantial in terms of avoiding reductions in individual well-being and productivity.

Association Between Social Pensions With Depression, Social, and Health Behaviors Among Poor Older Individuals in Colombia.

OBJECTIVES: Many low- and middle-income countries have introduced social pensions to alleviate extreme poverty and improve the well-being of older individuals. However, evidence remains inconclusive about the potential effects of such programs on mental health, social, and health behaviors. METHODS: Data for individuals aged 60 or older came from the nationally representative Encuesta Nacional de Salud, Bienestar y Envejeciamiento survey in Colombia 2015 (N = 9,456). We used propensity score matching to estimate the association between the country's social pension program (Colombia Mayor) with depression, self-rated health, food insecurity, alcohol consumption, social participation, and labor force participation. RESULTS: Results show that receiving the program does not significantly affect the likelihood of suffering from depression or self-rated health among either men or women. However, receiving the program is associated with significant reductions in the likelihood of experiencing food insecurity and significant increases in the likelihood of participating socially. Among women, receiving the program is associated with significant reduction in the likelihood of participating in the labor force. DISCUSSION: The absence of a measurable effect on depression and self-rated health may be explained, at least partly, by the program's comparatively small cash benefit and the sharing of resources with other family members. Policymakers should assess possibilities to maximize the health and social benefits of social pensions.

The Country That Never Retires: The Gendered Pathways to Retirement in South Korea.

OBJECTIVES: Among all Organization for Economic Cooperation and Development countries, South Korean older adults work until the latest age. We investigate the extent to which work experiences over the life course and family circumstances can be associated with older workers' incentives to remain in the labor force beyond the statutory pension age. We explore gender-specific patterns of labor force exit and labor force re-entry in later life. METHODS: Using panel data of South Korean older workers and retirees from 2006 to 2016, we estimate multilevel discrete-time models with random effects to predict their labor force transition process that unfolds over time. RESULTS: Results show that skilled manual workers are less likely to exit employment and more likely to re-enter the labor force. A longer history of self-employment is related to later retirement. The relationship between career characteristics and the risk of retirement is only significant for men. Late-aged employment transition among women appears to be more related to family conditions. Women who receive financial support from adult offspring are more likely to remain out of the labor force but this relationship is not pronounced among men. DISCUSSION: Policies aimed at extending working lives need to provide various types of social support to older job seekers, especially those who had low-class jobs and those without family networks.

Retirement, Pensions, and Depressive Symptoms Among Older Adults in China, England, Mexico, and the United States.

This study explores the associations of retirement, and of public and private pensions, with older adults' depressive symptoms by comparing differences between countries and age groups. Harmonized data were analyzed from the family of Health and Retirement Study in 2012-2013 from China, England, Mexico, and the United States (n = 97,978). Respondents were asked if they were retired and received public or private pensions. Depressive symptom was measured by the Center for Epidemiologic Studies Depression Scale. Retirement was significantly associated with higher depressive symptoms for the United States and with lower depressive symptoms for Mexico and England. Public pension was significantly associated with lower depressive symptoms for Mexico and with higher depressive symptoms for the United States and China. Private pension was significantly associated with lower depressive symptoms for the United States, China, and England. Our study shows that continuity theory demonstrates cross-national variation in explaining the association between retirement and depressive symptoms.

The Association Between the Basic Old-Age Pension and Depression of the Older Adults in Korea.

OBJECTIVES: The purpose of this study was to investigate the association between the Basic Old-Age Pension (BOP), which is a noncontributory pension, and depression in BOP beneficiaries in Korea. METHODS: We used the second and third waves (2007-2008) of the Korea Welfare Panel Study to identify the effect of the BOP on mental health in the year of its introduction. The Center for Epidemiological Studies-Depression Scale, applied in a Korean context, was used to evaluate mental health. To analyze the effect of the BOP, a difference-in-difference approach was used in analyses of all subjects and subgroups. RESULTS: For this study population of 760 adults, the BOP did not have a statistically significant relationship with depression in its beneficiaries. After controlling for type of household, the BOP was still not associated with lower reporting of depression, either in single-beneficiary or double-beneficiary households, in the year of the benefit. CONCLUSIONS: The BOP policy had no significant relationship with the level of depression among recipients. However, this should not be interpreted as implying that income subsidy programs for older adults, such as the BOP, do not affect mental health, considering the importance of economic hardship in this population and the program's socioeconomic effects.

Career and Financial Situation of Patients Diagnosed with Soft Tissue Sarcomas.

BACKGROUND: After receiving a cancer diagnosis patients face many challenges. The association between career situation and financial problems caused by cancer has a substantial impact on quality of life (QoL) among cancer patients. Indeed, the QoL such as physical and mental health of cancer patients is lower when the risk of psychological disorders or distress increases, and chances for cancer cure are reduced. Progress in therapeutic intervention allows many cancer patients a social reintegration into their careers. About one third of cancer patients are younger than 65 years, and with the constant increase in work life periods, a cancer diagnosis also presents a financial burden for those affected. OBJECTIVES: The main objective of this study was to analyse the social QoL in the context of factors related to career and financial situation among patients diagnosed with soft tissue sarcomas (STS). METHODS: A descriptive non-experimental research design was used to conduct a cross-sectional survey over a period of 6 months, between May and November 2016, in collaboration with the Sarcoma Unit at the Mannheim University Medical Centre, Mannheim, Germany, the patient organisation "Das Lebenshaus e.V.," and the German Pension Insurance Hessen (Deutsche Ren-tenversicherung: DRV Hessen)/Pension Fund. We analysed data of 30 patients diagnosed with STS using self-outcome questionnaires in combination with retirement insurance data from the date of first diagnosis up to 3 years afterwards. Out of 280 questionnaires, we received 86 completed forms, of which 56 were excluded. The remaining questionnaires of 30 patients were analysed according to self-determined outcomes and included a calculation of the financial changes caused by the disease. Only patients covered by pension insurance were included in the study. RESULTS: Thirty patients (24 women) whose median age at first diagnosis was 48.7 years (range 31-61 years) were included in the analysis. The average unemployment rate was 8.8 months, and for 67% (20 patients) the employment situation changed after the period of unemployment. Eight patients requested a retirement pension (reduced income insurance), 4 patients reduced their weekly working hours, and 3 patients lost their jobs due to complications of the disease. The data analysis revealed that, among these patients, one benefited from an income increase of about 24%, another one received a regular old-age pension, and 4 patients reported reduced income for other reasons. In total, mean income has been reduced by 26%. Considering only the 8 patients who applied for a pension, partial or total unemployment benefits resulted in an average loss of income of up to 62%. CONCLUSIONS: Reduced ability to work may cause severe financial problems for those affected by the diagnosis of STS. We found an average income reduction of 26%, for those requesting pension payments of 62%. This eventually relates to a higher risk of reduced wealth and may lower the patients' social standing.

Predictors of Health Insurance, Life Insurance, and Retirement Savings Among NYC's Immigrant Taxi and For-Hire Vehicle Drivers.

Taxi and for-hire vehicle (FHV) drivers are a predominantly immigrant population facing a range of occupational stressors, including lack of workplace benefits and increasing financial strain from tumultuous industry changes and now COVID-19's devastating impact. Bilingual research staff surveyed 422 New York City taxi/FHV drivers using a stratified sampling approach in driver-frequented locations to examine drivers' health and financial planning behaviors for the first time. Drivers lacked health insurance at double the NYC rate (20% vs. 10%). Life insurance and retirement savings rates were lower than U.S. averages (20% vs. 60%, 25% vs. 58%, respectively). Vehicle ownership was a significant predictor of health insurance, life insurance, and retirement savings. Compared to South Asian drivers, Sub-Saharan African drivers were significantly less likely to have health insurance and North African, and Middle Eastern drivers were significantly less likely to have retirement savings. Although most drivers indicated the importance of insurance and benefits, < 50% understood how to use them. Drivers felt primary care coverage to be most important followed by other health-related coverage, retirement benefits, and life insurance. Results reveal compelling addressable gaps in insurance and benefits coverage and the need to implement accessible financial literacy with navigation and advising services and programs.

Household income and retirement perspective among older workers in Germany-Findings from the lidA Cohort Study.

INTRODUCTION: In times of extending working lives, it is relevant to understand why, today, most workers leave employment long before regular retirement age. Financial factors have been central for explaining retirement timing, yet their impact seems rather complicated. This study explores the motivation to keep working, in relation to the economic household conditions among older workers and it investigates the impact of socio-demographic, individual and work factors on the motivation to keep working (MTW), again differentiated by economic household condition. METHODS: Based on data from wave three (2018) of the lidA Cohort Study, a representative interview study of socially insured employees born in 1959 or 1965 in Germany, descriptives and linear regression analyses were performed among 2835 employed participants. For all analyses, the sample was divided into five household equivalized net income groups. RESULTS: The groups with low and second lowest income were most motivated to work longer, followed by those with the highest income. The lowest income group exhibited most adverse scores for work indicators and health. Furthermore, in this group, MTW was unrelated to physical and mental health indicating that the comparably high motivation may be driven by financial imperatives. DISCUSSION AND CONCLUSIONS: The findings indicate that many workers with low income may find themselves forced to extend their working life, irrespective of their health. This requires increased attention by research as well as policy. Policy might have to acknowledge group specific negative side effects of regulations effectively extending working lives.

Unclaimed Defined Benefit Pensions Can Help COVID-19 Economic Recovery.

The COVID-19 economic crisis makes it vitally important that workers who earned defined benefit pensions receive them at retirement. Unfortunately, billions of dollars that could help cushion the financial shock are sitting unclaimed, because the people who they belong to cannot locate the company responsible for paying them. As defined benefit pension plans have been terminated, merged and moved over the years, large numbers of deferred vested participants have not been notified about their benefits. The widespread and growing practice of insurance company pension buy-outs can be especially problematic for participants without notice. Broader use of electronic disclosures for pensions also threatens to make the situation worse. In the wake of COVID-19, policy makers should take steps to ensure that pension benefits are part of the economic recovery.

Disease Control and Gender Predict the Socioeconomic Effects of Acromegaly: A Nationwide Cohort Study.

CONTEXT: Acromegaly is an insidious disease associated with severe somatic morbidity but data on socioeconomic status are scarce. OBJECTIVE: To study the socioeconomic status in acromegaly in a population-based follow-up study. METHODS: All incident cases of acromegaly (n = 576) during the period 1977-2010 were included. For every patient, 100 persons were sampled from the general population matched for date of birth and gender (comparison cohort). Cox regression and hazard ratios (HR), conditional logistic regression and linear regression with 95% confidence intervals (CI) were used. OUTCOME MEASURES: Retirement, social security benefit, annual income, cohabitation, separation, parenthood and educational level. RESULTS: The proportion of retired individuals was significantly higher in patients with acromegaly after the time of diagnosis (HR, 1.43; 95% CI, 1.26-1.62) and also during the 5-year pre-diagnostic period (HR, 1.15; 95% CI, 1.03-1.28). More individuals with acromegaly received social security benefit compared with the comparison cohort during the initial period after the time of diagnosis. Among patients who maintained a job, the annual income was similar to the comparison cohort. Compared with the background population, cohabitation was lower (HR, 0.69; 95% CI, 0.50-0.95) as was parenthood (HR, 0.56; 95% CI, 0.39-0.80), whereas neither educational level (HR, 0.61; 95% CI, 0.35-1.06) nor separation (HR, 1.13; 95% CI, 0.86-1.47) were different. Female gender and insufficient disease control were associated with a significantly worse socioeconomic status. CONCLUSIONS: 1) Socioeconomic status is impaired in patients with acromegaly even before a diagnosis of acromegaly. 2) Females and patients without disease remission have worse outcomes. 3) Early diagnosis and effective treatment of acromegaly could be important factors in mitigating the negative impact on socioeconomic factors.

Socioeconomic sequelae of drug abuse in a Swedish national cohort.

BACKGROUND: Drug abuse is frequently associated with negative sequelae such as reduced socioeconomic functioning. The extent to which these associations are attributable to a causal role of the disorder versus confounding factors that increase risk for both drug abuse and negative socioeconomic outcomes is unclear. METHODS: Drug abuse cases were identified using Swedish national medical, pharmacy, and criminal registers. Applying Cox proportional hazard models, we tested the association between drug abuse and four outcomes: early retirement, social assistance, unemployment, and income at age 50. We used co-relative models to determine whether familial confounding factors accounted for observed associations. RESULTS: In models adjusted for birth year, education, and early onset externalizing behavior, drug abuse was strongly associated with early retirement (hazard ratios [HR] = 5.13-6.28), social assistance (HR = 6.74-7.89), and income at age 50 (beta = -0.19 to -0.12); it was more modestly associated with unemployment (HR = 1.05-1.20). For social assistance and income (both sexes), and early retirement (women only), a model in which the association was partly attributable to familial factors fit the data well; residual associations support a partially causal role of drug abuse. For unemployment and early retirement among men, there was little evidence of familial confounding. CONCLUSIONS: The negative socioeconomic sequelae of drug abuse are likely due in part to familial confounding factors in conjunction with a causal relationship and/or unmeasured non-familial confounders. Relative contributions from distinct mechanisms differed across socioeconomic outcomes, which could have implications for understanding the potential impact of prevention and intervention efforts.

How children's education affects caregiving: Evidence from parent's last years of life.

Using data from the Health and Retirement Study (1994-2012), we studied the association between adult children's education and financial and caregiving support they provided to their aging parents in the last years of the parents' life. We controlled for the circumstances of parents' death, their functional limitations, whether they were in long-term care or home-care settings in the last year of their life, and in some models, various measures of parents' self-reported health. Estimates suggest that having a college degree and above has a significantly positive association with monetary transfers and knowledge support children provide to their parents. Estimates remained robust in models that included parent fixed effects. Evidence of children's education on instrumental support to parents was nonlinear in that although some college education increased instrumental support, but, a college degree did not have a statistically significant effect. Gender did not play a moderating role in the relationship between offspring education and support towards parents.

Living Alone in the United States and Europe: The Impact of Public Support on the Independence of Older Adults.

While we know that living alone is often associated with greater risk of financial hardship, we have limited knowledge on the possible link between the availability of public support and independent living. We use data from the 2014 Health and Retirement Study and the 2011-2015 Survey of Health, Ageing and Retirement in Europe to compare income and wealth profiles of the population aged 60 and above who are living alone in the United States and 19 European countries. We find that the likelihood of living alone is higher in generous welfare states, with social support and spending both positively associated with living alone. The relationship between personal resources and living alone has a smaller positive gradient in countries with robust welfare systems. The lack of adequate public support in less generous welfare states may constrain the ability of many low-income older adults without a partner to continue living independently.

Health Insurance Affordability Concerns and Health Care Avoidance Among US Adults Approaching Retirement.

Importance: As US adults approach Medicare eligibility at age 65 years, they face important decisions about health care and employment. Recent legislative, regulatory, and legal challenges to the Affordable Care Act may add new uncertainties to this decision-making. Objective: To understand adults' perspectives on health insurance, health care, and employment near retirement. Design, Setting, and Participants: In October 2018, a cross-sectional online survey study of community-dwelling US adults aged 50 to 64 years was conducted with Ipsos KnowledgePanel, a nationally representative internet survey panel (completion rate, 62%). The initial data analysis was conducted from November 2018 to March 2019, and additional analyses were conducted in November 2019. Main Outcomes and Measures: Confidence in affording health insurance, keeping a job or delaying retirement to have employer-sponsored health insurance, concerns about potential changes to health insurance associated with changes in federal policies, and avoidance of medical care or medication because of cost. Results: Among 1028 respondents aged 50 to 64 years (mean [SD] age, 57.0 [4.2] years), 51.8% (95% CI, 48.6%-55.0%) were female, 40.4% (95% CI, 37.2%-43.7%) had a high school education or less, 65.2% (95% CI, 62.1%-68.3%) were employed, and 34.8% (95% CI, 31.7%-37.9%) were retired or not working. Approximately one-fourth of respondents (27.4%; 95% CI, 24.6%-30.4%) had little to no confidence in being able to afford health insurance over the next year, and nearly one-half (44.6%; 95% CI, 41.4%-47.8%) had little to no confidence in their ability to afford health insurance when they retire; 14.1% (95% CI, 12.0%-16.5%) reported keeping a job and 11.4% (95% CI, 9.6%-13.6%) reported delaying or considering delaying retirement to have employer-sponsored health insurance. Most respondents (67.7%; 95% CI, 64.6%-70.6%) were very or somewhat concerned about potential changes to their health insurance associated with changes in federal policies. In the past year, 13.2% (95% CI, 11.2%-15.5%) of respondents did not get medical care and 11.9% (95% CI, 9.9%-14.1%) avoided filling a prescription medication because of cost. After adjusting for demographic and health characteristics, individuals with low confidence in health insurance affordability during either the next year or retirement were significantly more likely than those with higher confidence to avoid medical care (adjusted odds ratio, 2.89; 95% CI, 1.86-4.49; P < .001) and to avoid filling a prescription medication (adjusted odds ratio, 2.87; 95% CI, 1.71-4.80; P < .001) because of cost concerns. Conclusions and Relevance: Many adults aged 50 to 64 years worry about their ability to afford health insurance during retirement and about potential future changes to their health insurance options associated with changes in federal policy. Policy solutions are needed to help patients better understand their coverage options and navigate health care in this critical transition period before Medicare eligibility.