Longevity and Medicare: Not Perfect Together


This week, two high school seniors from Hunterdon County, New Jersey, received an award from the Family Career and Community Leaders of America (FCCLA) that most of our health-care policymakers could never win.

Catherine Owens and Kate Murray of the Polytech Career and Technical High School were awarded a gold medal for teaching middle-school children the benefits of yoga, journaling and mindfulness.

The Kids Have It Right

Learning about prevention and self-care at an early age is critical to the future health of our nation. Yet, US health policy historically takes a curative approach to health care, devoting little attention to…funding for…or education about prevention.

Don’t get me wrong. Our health system is one of the best in the world if you are ill. People from many nations come here if they can afford to when they have cancer or other diseases. They know the US is a forward-thinking place to be sick. But it is not such a great place to stay well.

Unfortunately, the US and all its citizens are paying the price for this focus on cure. Consider one of our most significant health issues—obesity and obesity-related conditions. We recognize and treat obesity under Medicare only after the problem materializes into a disease or medical condition. No doctor is required to ask an obese patient to get counseling unless that patient is already sick with diabetes or heart problems. Medicare does not pay for a gym or exercise program to keep you well, but it will pay if you are already morbidly obese.

Accordingly, Aging Analytics, a leader in analyzing health and economic data as related to aging, reported that in 2019 that 84% of our federal health-care dollars and 99% of our Medicare dollars are spent on chronic conditions.

Too often, medical advances are focused on keeping us alive longer with a disease rather than healthy longevity. But there is a breakthrough.

Recently actuaries, health-care policymakers and scientists are beginning to measure HALE—Health Adjusted Life Expectancy—not just longevity. HALE reports on healthy extra years.

What we find is that when HALE is the measure, the US is behind in healthy longevity per dollar spent in comparison with dozens of other countries. What’s more, despite our curative bent, we are not at the top of the list of countries in lifespan, healthy or not.

For example, Aging Analytics’ recent Metabesity Report compared us with 50 countries for HALE. In Singapore, the number-one country in healthy longevity, elders live about 6.7 years in ill health. In the US, it’s 10 years, and we live an average of eight years less than people in Singapore overall. Also, the US spends about 18% of its GDP (the highest in the world) on health care compared to Singapore at only 4.5%.

But with all we spend on health care, we pay out of pocket for the basic essentials of healthy aging.

Some years ago, I worked as a consultant to a 10-block housing project called Penn South in New York City. It was the first Naturally Occurring Retirement Community (NORC), where folks planned to age in place. The buildings had a gym, a social worker and a committee that enhanced aging services…ahead of its time.

The problem was that dentistry, eyeglasses and hearing aids were not covered by Medicare. As the residents put it—they were “out of pocket.” Together with the Presbyterian Senior Services, we created a type of credit card for businesses to give discounts in these three areas that are so essential for healthy aging.

I thought that things would have changed by now. But, sadly, no—according to Medicare.gov…

  • Dental: Medicare doesn’t cover most dental care, dental procedures or supplies, such as cleanings, fillings, tooth extractions, dentures, dental plates and other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you’re in a hospital. And Part A can pay for inpatient hospital care if you need to have an emergency or complicated dental procedure, even though dental care isn’t covered. But routine dentistry is just not included.
  • Eyeglasses: Medicare doesn’t usually cover glasses or contact lenses. However, Medicare Part B (Medical Insurance) helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens. Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses.
  • Exercise: Medicare does not pay for a gym or a yoga class. And don’t even think about meditation.
  • Hearing aids: I have written extensively about hearing in this blog—you can read these here and here. But again, as crucial as good hearing is to successful aging, there is still no hearing aid coverage through Medicare.

Now, the folks who make Medicare policy and our legislature are not intractable. They do move with the times. Medicare now covers…

  • E-visits with your doctors and certain other practitioners.
  • Telehealth: Medicare also covers telemedicine, a recent innovation.
  • Virtual check-ins: If you need a brief consultation with your health-care provider, check in virtually using your phone, text or another device.

And there is one small door open for having prevention covered by Medicare—the yearly wellness visit. After your first year of Medicare coverage, you are entitled to an annual wellness examination, covered by Medicare. At that wellness visit, you and your doctor can develop a personalized prevention plan to address protections for diseases and disabilities, based on your health and risk factors. The annual visit will include…

  • Your medical and family history
  • An updated list of current providers and prescriptions
  • Body measurements—height, weight, blood pressure
  • Personalized health counseling for wellness
  • A list of risk factors and treatment options for you
  • A screening schedule (like a checklist) for appropriate preventive services
  • Advance care planning
  • If you wish, a cognitive impairment assessment for signs of Alzheimer’s disease or dementia

Ok…what’s next?

That depends. We cannot pay for the likes of massage, vacations and facials, although these all arguably are part of wellness. Yet, neither can we maintain the cost of longevity without health. I have a suggestion. Let’s make medical devices such as blood pressure monitors and medicine such as metformin that would be useful in reversing or delaying the diseases of aging available to healthy people. As of now, they cannot be approved for the public because under FDA regulation aging is not a disease.

Dr. Nir Barzilai, author of Age Later: Health Span, Life Span, and the New Science of Longevity, suggests that we consider age-related disease prevention a target of our health-care system, without the social stigma that might ensue from making aging itself an illness just for regulatory purposes. Perhaps seeing the vulnerability of our elders to COVID-19 will make us aware that aging well starts at an early age as a combination of personal health habits and health-care policy (with some genetics and luck thrown in). The kids from Hunterdon know this. How about us?