• We study the impact of widowhood on out-of-pocket health spending among the elderly.
• Out-of-pocket health spending rises by about 24 percent upon widowhood.
• This increase is largely driven by spending on nursing homes.
• As women live longer than men, more women than men are widowed at any age.
• This explains about one third of the gender difference in out-of-pocket spending
Despite the presence of Medicare, out-of-pocket medical spending is a large expenditure risk facing the elderly. While women live longer than men, elderly women incur higher out-ofpocket medical spending than men at each age. In this paper, we examine whether differences in marital status and living arrangements can explain this difference. We find that out-of-pocket medical spending is approximately 24 percent higher when an individual becomes widowed, a large portion of which is spending on nursing homes. Our results suggest a substantial role of living arrangements in out-of-pocket medical spending. Our estimates combined with differences in rates of widowhood across gender suggest that marital status can explain about one third of the gender difference in total out-of-pocket medical spending, leaving a large portion unexplained. On the other hand, gender differences in widowhood more than explain the observed gender difference in out-of-pocket spending on nursing homes.