The Medicare Program’s Challenges And Lessons


Numerous issues that affect the efficiency of the current US healthcare system have long been in the centre of heated debates. The abundance of economic theories that continue to be the cornerstones of many perspectives on politics, do not allow for rapid transformation of the entire system. At the same time, it is crucial to provide millions of people with affordable options to have access to the increasingly expensive health care services. Medicare has substantially increased the percentage of older adults and younger beneficiaries with disabilities who have an insurance covering the most vital expenses related to the treatment of their illnesses.

Funding Issues

Medicare, alongside Medicaid and some other initiatives, is a part of the affordable US healthcare system. According to Hansmann (2022), the program begun in 1965 under the Social Security Administration (SSA) and now is administered by the Centers for Medicare and Medicaid Services (CMS). Its efforts are focused on Americans aged 65 and older, as well as younger people with disability status. Unlike Medicaid, Medicare is a social insurance program that relies on federal funding. Moreover, this program is generally considered to be extremely useful by almost all members of the American society. Nevertheless, despite serving crucial social functions, the history of the development and the establishment of the program features numerous challenges.

Currently, one of the most frequently discussed topics concerning Medicare centres around its funding. Although the structure of funding was a politicized issue several decades ago, current funding challenges are largely connected to the size of the funds, the benefit payments, and the number of beneficiaries. The latter has become a major topic for research and analyses among both politicians and economists. The overall healthcare costs continue to increase rapidly every year (Cubanski et al., 2019). Moreover, the enrollment also shows steady growth, as the population ages. At the same time, immigration does not seem to help in balancing the workers to enrollers ratio. All the above mentioned will eventually lead to serious issues that can be addressed primarily by allocating sufficient federal funds.

Coverage Issues

Although the use of new technologies has facilitated the enhancement of even basic medical services, the enormous increases in the insurance costs continue to be a major threat for sustainable development in general. Moreover, among the modern challenges that Medicare faces is the issue of dental coverage. Medicare does not cover routine dental care, and the majority of people on Medicare have no dental coverage at all (Freed et al., 2019). The issue has already been widely discussed multiple times by a number of officials, healthcare workers and economists.

The program should also use its prior experience to encourage new providers to establish hospitals in rural areas. Currently, many rural communities nationwide do not have decent access to primary care and preventive services. While urban areas have 263 specialists for every 100,000 individuals, rural areas only have 30 specialists for every 100,000 rural residents (Lahr et al., 2019). Americans who live in rural areas should have an easy access to federal insurance program’s services. Therefore, Medicare should consider motivating various partners from the private sector to set up new facilities in remote areas.

Lessons Learned

The Medicare program seeks to promote its services nationwide in order to provide affordable healthcare to all seniors and people with disability status. Two decades ago, the National Medicare Education Program (NMEP) was introduced to educate beneficiaries about their Medicare program benefits; health plan choices; supplemental health insurance; beneficiary rights, responsibilities, and protections. Medicare spending is on a slower upward trajectory now than in past decades (Cubanski et al., 2019). Therefore, the officials in charge of Medicare continue to learn from experience and rapidly transform the program to meet the society’s growing demands.

The Medicare program continues to increase its dependence on private health insurers. According to Herd (2021), in 2020, nearly 40% of beneficiaries were exclusively in private health insurance, via their participation in Medicare Advantage, with estimates that this could reach 47% by 2029. Many people believe that federal social insurances in most cases should not rely on the price-quality ratio of private insurers. When the Affordable Care Act was introduced, it featured certain drawbacks, such as paying extra for a plan that may include unnecessary benefits.


Currently, some people also point to the fact that the Act has led to the unprecedented loss of company-sponsored health plans and the emergence of numerous strategies used by companies to avoid paying for employees’ private insurances. Nevertheless, Medicare remains the least controversial of all the social security programs related to medicine. The development of insurance schemes that suit the elderly and people with disability status should be perceived as the main function of this federal program. Therefore, Medicare should apply its expertise to reduce dependence on private sector more often. Politicians and technocrats should bear in mind the original purpose of the program and manage it in a way that can fully realize its potential as a unique social security program.


Cubanski, J., Neuman, T., & Freed, M. (2019). The facts on Medicare spending and financing. Kaiser Family Foundation.

Freed, M., Neuman, T., & Jacobson, G. (2019). Drilling down on dental coverage and costs for Medicare beneficiaries. Kaiser Family Foundation.

Hansmann, K. J. (2022). Medicare 101: Navigating the rules for coverage and benefits in clinical practice. Family Practice Management, 29(1), 21–25.

Herd, P. (2021). Making Medicare complicated: How privatizing Medicare is increasing administrative burden for beneficiaries. Public Policy & Aging Report, 31(4), 133–138.

Lahr, M., Neprash, H., Henning-Smith, C., Tuttle, M. S., & Hernandez, A. M. (2019). Access to specialty care for Medicare beneficiaries in rural communities. The University of Minnesota Rural Health Research Center.