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Objective. To inform state policy discussions about the insurance coverage of the near elderly in West Virginia (WV) and the impact of the uninsured near elderly on hospitals in the state. Data Sources. 2003 West Virginia Uniform Bill (UB) hospital discharge data. The data represent all adult inpatient discharges in the state during the year. Study Design. We compare the near elderly with other adults and examine differences by insurance status. Key variables include volume of discharges, health insurance coverage, patient characteristics, and charges incurred. Findings. The near elderly constitute the largest group of nonelderly adult inpatient hospital discharges. They are more likely than younger adults to be admitted for emergency conditions; have comorbidities and complications; have longer hospital stays; and incur higher charges on average. Although the near elderly are least likely to be uninsured, they represent the second largest group of uninsured discharges and incur the most in uninsured charges. Conclusions. The specific needs of the near elderly warrant consideration in WV's (and other states') ongoing development and evaluation of policies aimed at reducing uncompensated care costs, including programs to expand access to health insurance and primary and mental health care among the uninsured. [ABSTRACT FROM AUTHOR]