Americans are living longer than they did in 1965, when Medicare was created. At the time, the average life expectancy in the US was about 70 years; today it is about 77.5 years – slightly down from a record of almost 79 before the pandemic. Women celebrate their 65the According to the Social Security Administration’s Life Expectancy Calculator, today’s birthdays can live to about 86 years, and men can live to 84 years. That also means we need another 20 years of Medicare benefits.
Our longer lifespans are due to reduced infant mortality, improved public health and better management of chronic diseases. But Medicare was never designed to help us live that long, and services have sometimes been slow to adapt to the needs of an aging population, some experts say. According to the Population Reference Bureau, social security and health care spending will rise from a combined 9.1% of gross domestic product (GDP) in 2023 to 11.5% in 2035 due to the large share of older people in need of care. That could lead to higher taxes and cuts to services, they predicted.
Boomers, who will all be over 65 by 2030, tend to be obese, have some form of disability and have more chronic conditions, according to a study by researchers at the USC Schaeffer Center for Health Policy in Economics. “The size of the older population is likely to have the biggest impact on spending in the future,” they said.
It’s taken decades of work, but Medicare is better at addressing the health problems of this growing older population, said Anne Montgomery, senior analyst at the National Committee to Preserve Social Security and Medicare. “It’s not that there haven’t been efforts to update Medicare, and gradually we’ve created a better program, but we still have a long way to go to get it updated,” she says.
Medicare only added prescription drug coverage in 2003, and advocates are still working on coverage for dental, vision and hearing, as well as additional long-term care services and support. We’re not there yet, says Montgomery, a former senior adviser to the U.S. Senate Special Committee on Aging. While some Medicare Advantage plans offer these benefits, traditional Medicare does not.
“It’s really incumbent on policymakers and experts to think hard and think creatively and innovatively about how we can strengthen original Medicare,” she says.
Some policy analysts argue that a strategic focus on reducing the prevalence of chronic diseases could substantially help Medicare’s finances. About one in ten Medicare beneficiaries are responsible for about 75% of the program’s annual expenditures. An overwhelming majority of these people have chronic illnesses. Older adults with one or more chronic conditions tend to incur medical costs that are three to ten times higher per capita, compared to their healthier counterparts.
Obstacles remain to keeping patients healthier, for reasons that are not always clear to doctors or patients.
According to an analysis by Deloitte, boomers are more likely to be obese than their older peers. However, Medicare may not cover most newer weight loss medications known as GLP-1 agonists (such as Wegovy and Zepbound) to treat obesity.
Only after a labeling change by the FDA did Medicare get the green light to treat the drug Wegovy, but only for people who are overweight or obese and who are also at high risk of heart attack or stroke. Without insurance coverage, these medications can cost more than $12,000 per year.
Medicare out-of-pocket costs can impact disease management
In addition to the cost of weight loss medications, other out-of-pocket expenses can contribute to how well Medicare beneficiaries manage their chronic conditions. Some medications can be expensive, and although the Inflation Reduction Act has capped annual drug spending at $2,000 by 2025, these costs can be a burden for some.
Even the traditional Medicare chronic disease treatment program, which pays a doctor to manage a person’s care if they have two or more chronic conditions expected to last more than a year, can incur additional costs . The program includes a comprehensive care plan, monthly doctor visits, medications, community services and care coordination. However, there is also an additional monthly fee, along with Part B’s deductible and coinsurance. These costs can add up quickly and pose a financial barrier for some recipients.
Improvements in preventive care
Medicare is trying to keep up with the health care needs of older adults through other services. The Affordable Care Act strengthened Medicare’s coverage of preventive care and added annual wellness visits, Montgomery points out.
Preventative coverage is comprehensive, including screenings for bone health, colon and breast cancer, and diabetes self-management training. Medicare also covers most age-appropriate vaccines, screening and mental health services, nutritional therapy services, and alcohol and drug abuse therapies, along with dozens of other types of care.
Despite these efforts, U.S. health care spending is more than twice that of all other industrialized countries, yet our life expectancy is 4.5 years shorter than in those other countries, said Senator Bernie Sanders (I-VT). Sanders has been pushing for universal health care, or “Medicare for All,” for decades. Montgomery says that given the current polarization in Congress, this idea isn’t going anywhere anytime soon.
Sanders’ big-picture vision is still valuable, as is envisioning a new approach to services and supports in the long term, Montgomery said. It reminds us that there are still many missing pieces to addressing the health, well-being and longevity of our increasingly aging population.
“I don’t think we should give up yet. I think we need to double down and move faster,” she says.