We can thank reduced infant mortality, improved public health, and better chronic disease management for our increased longevity. But Medicare was never designed to help us live this long, and services have sometimes been slow to adjust to the needs of the aging population, say some experts. Social Security and Medicare expenditures will increase from a combined 9.1% of gross domestic product (GDP) in 2023 to 11.5% by 2035 because of the large share of older adults needing care, according to the Population Reference Bureau. That could lead to higher taxes and service cuts, they predicted.

Boomers, all of whom will be over 65 by 2030, will be typically obese, have some type of disability, and more chronic conditions, a study by researchers at the USC Schaeffer Center for Health Policy & Economics found. “The size of the elderly population in the future likely will have the highest impact on spending,” they said.

It’s taken decades of work, but Medicare is better at addressing more health conditions seen in this burgeoning older population, according to Anne Montgomery, senior analyst with the National Committee to Preserve Social Security and Medicare. “It’s not that there haven’t been efforts to try to update Medicare, and gradually we have created a better program, but we still have a long way to go to tweak it,” she says.

Medicare did not add prescription drug coverage until 2003, and advocates are still working to get dental, vision, and hearing coverage, as well as additional long-term-care services and supports. We’re not there yet, says Montgomery, a former senior advisor for 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. Approximately one in every 10 Medicare beneficiaries is responsible for some 75% of the program’s annual expenditures. An overwhelming majority of these individuals have chronic illnesses. Older adults with one or more chronic conditions tend to incur medical costs that are three to 10 times greater per capita, compared to their healthier counterparts.

Roadblocks to keeping patients healthier remain, for reasons that aren’t always clear to physicians or patients.

Boomers have higher rates of obesity than their older peers, according to an analysis by Deloitte. Medicare, however, is prohibited from covering most of the newer weight loss drugs, known as GLP-1 agonists (such as Wegovy and Zepbound), to treat obesity.

It was only after an FDA labeling change that Medicare green-lit coverage of the drug Wegovy, but only for people who are overweight or have obesity and are also at high risk of heart attack or stroke. Without insurance coverage, these medications can cost more than $12,000 a year. 

Medicare’s out-of-pocket costs may impact disease management

In addition to the cost of weight loss drugs, 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 expenditures at $2,000 effective in 2025, this cost may be a burden for some.

Even traditional Medicare’s chronic disease management program, which pays a physician to manage a person’s care if they have two or more chronic conditions expected to last more than a year, can mean additional costs. The program includes a comprehensive care plan, monthly physician visits, medications, community services, and care coordination. However, there is also an additional monthly fee, along with Part B deductibles and coinsurance. These charges can quickly add up and become a financial barrier for some recipients.

Preventive care improvements

Medicare is attempting to keep pace with the 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.

Preventive coverage is comprehensive, including screenings for bone health, colon and breast cancer, and diabetes self management training. Medicare also covers most age-appropriate vaccines, mental health screening and services, nutrition therapy services, and alcohol and drug misuse therapy, along with dozens of other types of care.

Despite these efforts, health care spending in the U.S. is more than twice that of every other industrialized nation, yet our life expectancy is 4.5 years less than in those other countries, according to Sen. Bernie Sanders (I-Vt.). Sanders has been pushing for universal health coverage, or “Medicare for All,” for decades. Montgomery says given the current polarization in Congress, that idea isn’t going anywhere for now.

Sanders’s big-picture vision is still valuable, as is envisioning a new approach to long-term services and supports, according to Montgomery. It’s a reminder that there are still many missing pieces to address the health, well-being, and longevity of our increasingly older population.

“I don’t think we need to give up yet. I think we need to double down and go faster,” she says.