9 Jun 2022


Challenges Facing Medicare

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For the last fifty years, Social Security and Medicare have worked to ensure some level of financial security, as well as access to the most needed healthcare for all Americans in their old age. However, Medicare has faced and continues to face a lot of challenges which may hinder its effectiveness (Neuman et al., 2015) . This paper examines some of the problems that Medicare faces in the quest to offer quality healthcare to aging Americans. 

The first challenge regards the funding of the program. Studies have predicted that the Annual Medicare Expenditure is expected to rise from $207 billion in 2003, to an estimated $3 Trillion by 2030 (Neuman et al., 2015) . Following this, it is possible that the spending of Medicare will become an even much larger section of the federal government spending, which will, in turn, affect the funding of other essential national programs such as health, education, national defense, and environment protection. 

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Similarly, even as the Medicare program faces financial difficulties, the beneficiaries also suffer high financial costs. As of now, Medicare beneficiaries pay about 30% of their healthcare costs from their pockets. Statistics show that in 1997, these costs amounted to an average of $2,653 per person for premiums, products, and services not being covered by Medicare (Neuman et al., 2015) . Other services that beneficiaries are paying for out-of-pocket include eyeglasses, dental care, and long-term supports and services. Studies show that in the future, these out-of-pocket expenses are expected to increase. Currently, Medicare covers only a small portion of health services, including prescribed drugs. Additionally, Medicare lacks an out-of-pocket cap, which is the essential role of insurance coverage. For this reason, therefore, Medicare households spend significantly more on health as compared to non-Medicare families (Cubanski et al. , 2015) 

Another significant challenge that faces Medicare and the nation at large involves preventing chronic illnesses and devising better methods to meet the needs of patients with multiple chronic diseases. Today, about 10% of the Medicare beneficiaries account for 58% spending ( Cubanski et al. , 2015). Neuman et al. (2015) point out that as Medicare beneficiaries live longer and enjoy better health services, they have the likelihood of developing multiple co-morbidities and illnesses, therefore adding to the need and complexity of their care and other related costs. These complexities have severe implications for team-based care, patient engagement, medical training, end-of-life-care, and caregiver support. This situation would, therefore, mean that Medicare will require additional funding and support, which will further add to pressure on the national budget and will hurt the provision of other vital resources. 

Lastly, Medicare faces another challenge of increasing population of baby boomers. Currently, the population of Medicare beneficiaries has grown to include 45 million people who are aged 65 and older and another 8 million adults who are younger than 65 and qualify for Medicare due to permanent disabilities. Although some people on Medicare enjoy flourishing health as well as a comfortable retirement, many still have significant frailties and health needs. Almost half of all Medicare beneficiaries have more than three chronic illnesses, about one third have cognitive or mental disorders, and about a third have functional disabilities ( Cubanski et al. , 2015). This numbers, therefore, predict that over the next few years, the number of Medicare beneficiaries will increase, and at the same time, the Medicare population composition will shift. With even more people living into their old age, more and more people will develop multiple conditions and will require even higher care. 


Cubanski, J., Swoope, C., Boccuti, C., Jacobson, G., Casillas, G., Griffin, S., & Neuman, T. (2015). A primer on Medicare: key facts about the Medicare program and the people it covers.  Henry J. Kaiser Family Foundation . Retrieved from https://www.kff.org/medicare/report/a-primer-on-medicare-key-facts-about-the-medicare-program-and-the-people-it-covers/

Neuman, T., Cubanski, J., Huang, J., & Damico, A. (2015). The rising cost of living longer: Analysis of Medicare spending by age for beneficiaries in traditional Medicare. The Henry J. Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/report/the-rising-cost-of-living-longer-analysis-of-medicare-spending-by-age-for-beneficiaries-in-traditional-medicare/

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