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Data: Centers for Medicare & Medicaid Services; Chart: Andrew Witherspoon/Axios

Retirement in America is growing less secure, physically and financially, given the omnipresent threat and cost of serious illness or disease.

Why it matters: Qualifying for Medicare does not guarantee that older adults will skirt potentially ruinous medical bills. Millions of seniors have also come to rely on the taxpayer-funded program for lower income people — Medicaid — and there's no indication that will slow down.

  • "I can't tell you how many times people talk about how unaffordable the costs are, how it wipes away life savings in short order," said Tricia Neuman, a Medicare policy expert at the Kaiser Family Foundation.

By the numbers: More than 12 million Americans — most of them over 65 — have both Medicare and Medicaid coverage.

  • That represents about one-fifth of all Medicare enrollees, a percentage that has stayed stable over time even as more baby boomers enter the program.
  • This low-income population has some of the most expensive health care conditions and disabilities — averaging roughly $30,000 in annual spending per person, or double the average Medicare enrollee.

Between the lines: Some people who age into Medicare have very few assets and income, and therefore automatically qualify for Medicaid. But retirees who consider themselves middle-class increasingly have to resort to Medicaid because the costs of things like dementia or nursing home care consume their entire nest egg.

  • "The real challenges are for people who are just above the Medicaid eligibility level," Neuman said. "They're really left to fend for themselves."

What to watch: The federal government has been experimenting with ways to coordinate care better for this population, but that's a reaction to seniors falling into poverty due to health care costs.

  • Unless policymakers address the high and rising costs of care, more retirees and their families will have to depend on both Medicare and Medicaid.

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