Having health insurance in retirement, as almost all federal employees and retirees do through the FEHB program, does not necessarily guarantee that medical costs won’t be a major financial burden, according to a Kaiser Family Foundation study.

“While the chances of falling into medical debt are greater for people who are uninsured, most people who experience difficulty paying medical bills have health insurance. Medical debt can arise when people must pay out-of-pocket for care not covered by health insurance or to which cost-sharing (such as deductibles) applies. Medical debt might also result from health insurance premiums that individuals find difficult to afford,” it said.

Medical costs can force people to choose among basic necessities and can lead to indebtedness including in some cases bankruptcy, it said. Such problems can in turn cause those persons to drop health insurance as unaffordable, making them even more vulnerable to large costs such as might occur after an injury or illness. Injuries or illnesses can have the further effect of impairing the individual’s ability, or a spouse’s ability, to work, creating further pressure.

At the minimum, people experiencing medical debt commonly take steps such as reducing savings for their own retirement or savings for children’s college education—or drawing money from savings already accrued.

The report added that although lower-income persons are more vulnerable, medical debt “can affect almost anyone” including those with higher annual incomes. The risk also can be found in all age groups and all family sizes.