Wharton Pension Research Council Working Papers

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Working Paper

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Theoretical research suggests that health expenditure risk can have an ambiguous influence on the annuitization decisions of the elderly. I provide empirical evidence on this linkage, by estimating the impact of supplemental Medicare insurance (Medigap) coverage on the annuity demand of older Americans. I use local variation in prices as an instrumental variable to address the possible endogeneity of Medigap coverage, an identification strategy motivated by the fact that Medigap policies are not medically underwritten, and Medigap insurance is required by law to be standardized, so prices reflect neither individual characteristics nor product quality. Medigap coverage has a strong impact on annuitization: the extensive margin elasticity is 0.39, the overall elasticity of private annuity income with respect to Medigap coverage is 0.56. These results are robust to controls for health, wealth, and preferences, as well as other robustness tests. They imply that medical expenditure risk has a large impact on underannuitization.

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Copyright/Permission Statement

All findings, interpretations, and conclusions of this paper represent the views of the authors and not those of the Wharton School or the Pension Research Council. © 2012 Pension Research Council of the Wharton School of the University of Pennsylvania. All rights reserved.


The project described was supported by the National Institute on Aging, P30 AG-012836-18, the Boettner Center for Pensions and Retirement Security, and National Institutes of Health – National Institute of Child Health and Development Population Research Infrastructure Program R24 HD-044964-9, all at the University of Pennsylvania. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute of Aging or the National Institutes of Health.

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Date Posted: 28 June 2019