Most U.S. states have one or more renewal provisions specific to older drivers, such as shorter renewal cycles, required vision or road testing, and in-person rather than mail or electronic renewal. The ages at which special regulations are required vary by state.
Regulations requiring in-person renewal or vision testing are associated with lower fatality rates among among drivers age 85 and older (Tefft, 2014).
Some states have recently relaxed in-person renewal requirements. A study of these changes found that increasing the time between renewals was associated with higher injury rates among drivers 75 and older (Hamann et al., 2025). Allowing remote renewals some of the time was associated with increased crash rates for drivers ages 65-74.
Fatality rates per licensed driver 55 and older aren’t lower in states with laws requiring road testing, knowledge testing or shortened renewal periods for older drivers than in states without such requirements (Tefft, 2014).
HLDI studies on mandatory road tests in Illinois and New Hampshire showed that the effect on insurance claim rates is mixed.
Claim rates were lower for drivers 75 and older in Illinois, compared with surrounding states without road test requirements (HLDI, 2016). HLDI also found that people 75 and older were less likely to be insured in Illinois than in surrounding states, which suggests that the road test requirement discouraged some older people from continuing to drive.
In contrast, New Hampshire didn’t see the same benefit from the road test requirement, which was in effect for drivers 75 and older until 2011 (HLDI, 2016).
Effective July 1, 2026, Illinois loosened its road test requirement, changing the starting age from 75 to 87.
An Australian study found that drivers 80 and older in jurisdictions with age-based mandatory medical and/or road tests didn't have lower fatal and serious injury crash involvement rates per capita or per licensed driver compared with drivers in a jurisdiction without age-based mandatory testing (Langford et al., 2004). Some jurisdictions with mandatory age-based testing had significantly higher fatal and serious injury crash rates than the jurisdiction without age-based testing.
Some states impose restrictions on older drivers if an assessment finds they are warranted. Possible restrictions include no driving on high-speed roads, outside a certain area or at night.
Drivers may be subject to evaluations by licensing agencies based on referrals from police, physicians, family, or observations by personnel at licensing offices. States may establish policies for further testing that include vision screening, road tests, knowledge tests or evaluations by medical advisory boards.
An IIHS study of a restricted licensing program in Iowa found that drivers 70 and older who were identified for further testing reported more visual impairments, prescription medications and physical mobility limitations than older drivers not identified for further testing (Braitman et al., 2010). Many drivers who received restrictions had already decided to decrease or self-regulate their trips by driving less or reducing or eliminating driving in risky situations, such as at night. The restrictions appeared to reinforce those decisions.
Studies on the effects of license restrictions on crashes have produced varied results. One study of older drivers in British Columbia found that when age and gender were taken into account, drivers who were restricted remained crash-free for longer after license renewal than unrestricted drivers (Nasvadi & Wister, 2009). Other studies have reported mixed findings for the effects of restrictions on crashes (Langford & Koppel, 2011; Stutts et al., 2000).