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Which SDOH do seniors want health plan benefits to address?

Aging in place, access to healthcare and economic insecurity are leading SDOH affecting senior health and wellbeing.

Sara Heath, Executive Editor

Published: 25 Sep 2025

Aging in place, access to healthcare and economic insecurity are the biggest social determinants of health affecting health and wellbeing for America's seniors, offering insights into the benefits individuals need from their health plans, according to a new report from Alignment Health.

The report, based on survey responses from 2,200 Americans over age 65, serves as a roadmap for key health plan benefits, Alignment Health, a Medicare Advantage plan, said.

"Our annual survey looks beyond the medical diagnosis and provides a full picture of seniors' state of being, their desires in aging and what support they need to reach their optimal level of aging as they wish," Dr. Ken Kim, chief medical officer at Alignment Health, said in a press release.

By understanding the leading SDOH affecting senior health and wellbeing, Kim indicated that health plans like Alignment Health can better design benefits for members.

Seniors need support to age in place

Coming in as a top priority for America's seniors is to age in place, with 64% of respondents saying they'd like to live independently in their own homes for as long as possible.

But according to the survey, seniors face a litany of barriers to doing so. Seniors' homes are not designed to accommodate independent living for an individual who is aging and potentially facing physical or functional limitations.

Notably, 64% of respondents said they'd use benefits that cover safety rails, personal medical safety alerts, memory care and assistance with end-of-life care planning.

Healthcare access elusive for folks over 65

The second biggest SDOH barrier to health and wellbeing for seniors includes healthcare access, with 60% of respondents saying as much. Problems like long appointment wait times and limited access to healthcare technologies, such as telehealth.

Notably, 54% of respondents said they've skipped care because they faced too many care access issues. Of those who have never skipped care, 45% acknowledged that they might have to do so in the future.

Seniors face affordability problems

Coming in as the third-leading SDOH affecting health for seniors is economic insecurity. Around a quarter (27%) of respondents said concerns about money ranks among their top three stressors. For 13% of respondents, money has ranked as their top stressor over the past year.

Alignment Health did not indicate that there was a link between financial distress and healthcare access problems, but it would be remiss not to mention the connection. For many patients, regardless of age, financial insecurity can limit healthcare access or medication adherence.

Loneliness affects senior health

Long acknowledged as a key SDOH affecting seniors, loneliness now affects the health of around 2 in 5 adults over age 65, the survey showed. Individuals reporting loneliness experience symptoms like depression, anxiety, decreased physical activity and sleep disturbances.

Medical debt increases for seniors

According to the survey, the number of seniors reporting economic insecurity and carrying medical debt has remained unchanged since last year, with 44% reporting both issues.

However, the total cost of medical debt continues to grow.

Around a quarter (26%) of respondents who have medical debt said their debt equals at least four months of their living expenses. That's 8 percentage points more than the number of individuals saying as much in 2024.

Seniors report limited access to social services

Ranking as the fourth leading factor affecting senior health and wellbeing is access to social support, with 34% of seniors reporting barriers. Social support can range from in-home care to navigating health information, Alignment Health noted.

More specifically, seniors reported issues with transportation access, which ranked as the fifth leading factor limiting senior wellbeing. Around 3 in 10 (31%) of seniors said they don't have safe, reliable transportation to get to doctor visits, fill prescriptions or complete everyday activities such as grocery shopping.

Mental health challenges persist

Finally, the report noted that mental health concerns ranked as the sixth biggest barrier to senior health and wellbeing.

A fifth of respondents reported sometimes or often feeling depressed, with this problem getting worse for 22% of respondents.

Understanding SDOH for benefits design

According to Alignment Health, understanding these key SDOH is important for benefits design.

For example, assessing loneliness and depression as growing problems for senior patients can and should spur benefits that offer companionship and mental healthcare access.

"Where they live, how they get care and the support systems around them can change their health trajectory -- for better or worse," Kim said of the survey. "These insights not only shape how we specifically design our benefits, services and partnerships, but we hope these insights provide direction for others working in senior health."

Sara Heath has reported news related to patient engagement and health equity since 2015.