The accident happened in Pittsburgh on November 16. Joseph Masterson, a lawyer who was just days from retiring at age sixty-three, suffered cardiac arrest while driving, plowed into a guardrail, and lost consciousness.

Other drivers stopped, broke the car window, and pulled him to safety. A passing volunteer firefighter performed CPR until an ambulance arrived to take Masterson to UPMC Mercy hospital.

He spent eighteen days in the medical intensive care unit there, forteen of them on a ventilator. He developed delirium, a common ICU condition, and needed antipsychotic drugs. Despite a feeding tube, he lost weight. “We honestly weren’t confident that he would pull through,” said Ron Dedes, his brother-in-law.

But he did. Masterson was discharged February 1 and returned home with near-constant family support. Working diligently with several kinds of therapists, he has regained his ability to walk, despite lingering weakness, and to manage his personal care. His once-garbled speech has markedly improved. He can make himself a sandwich.

Now, “our biggest concern is his memory,” Dedes said. Masterson, who so recently handled complex legal matters, forgets conversations and events that happened a few hours earlier, said Patti Dedes, his sister. He can’t yet operate a microwave or place a phone call.

In an interview, he described himself, accurately, as “much, much better than I was” — but misstated his age. Screening tests after his discharge indicated cognitive impairment and depression.

Among critical-care doctors, prolonged symptoms like his are known as “post-intensive care syndrome,” or PICS. The fallout can be physical or psychological, as well as cognitive, and can persist for months or years.

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More than five million people annually are admitted to intensive care across about 5,000 American hospitals, and research shows that more than half experience such aftereffects. Older age increases the odds.

Patients and families are often startled by these continuing difficulties. “The belief is that they’ll be discharged from the hospital and in two or three weeks, they’ll be back to normal,” said Brad Butcher, who was Masterson’s doctor and wrote about PICS recently in the medical journal JAMA. “That doesn’t comport with reality.”

In fact, with greater ICU use and improved treatments — the Society of Critical Care Medicine estimates that 70% to 90% of adults now survive their stays — the population likely to encounter the syndrome is growing.

“Everyone is grateful that the patient has survived,” said Lauren Ferrante, a pulmonary critical-care doctor and researcher at the Yale School of Medicine. “But that’s just the start of a long road to recovery.” In a study of patients 70 and older that she co-authored, within six months after discharge only about half had returned to their pre-ICU functional ability.

Intensive care patients face a long list of challenges. PICS symptoms range from the physical — weakness, pain, neuropathy (tingling in arms and legs), and malnutrition — to mental health concerns, primarily anxiety and depression. Cognitive difficulties like Masterson’s are commonplace, including problems with memory, attention and concentration, and language.

“For many people, surviving a critical illness is a life-altering experience,” Butcher said. Patients in intensive care after emergency or elective surgery also have high rates of new physical, mental, and cognitive problems a year later.

The same aggressive treatments that save lives contribute to the syndrome. Intensive care patients “have some sort of dramatic organ failure that requires immediate attention” and constant monitoring, explained Carla Sevin, a pulmonary critical-care doctor who directs the ICU Recovery Center at Vanderbilt University Medical Center.

That could mean a breathing tube attached to a ventilator, which in turn often requires sedating drugs. Sedation “can precipitate delirium, and delirium is the key factor in cognitive symptoms,” Butcher said.

It doesn’t help that constant beeps and alarms from monitors and round-the-clock bright lighting disrupt sleep, and that restrictive family visiting hours deprive patients of reassuring faces and voices.

Gregory Matthews, a retired accountant in St. Petersburg, Florida, spent nearly a month in an ICU after a lung transplant in 2014. He still vividly remembers his hallucinations, including mice running across the wall and someone trying to frame him for drug running.

“One day, I thought a doctor was an assassin — I could see the rifle,” said Matthews, now eighty. “So I jumped out of bed,” he said, and yanked out his IVs. The staff put his arms in restraints for days.

But immobilization exacts its own toll as patients quickly lose muscle mass and strength. “Our bodies were not meant to lie in bed all day,” Ferrante said.

Psychologically, “PTSD is pretty common, similar to what’s seen in combat veterans or sexual assault survivors,” Sevin said, referring to post-traumatic stress disorder. Families can suffer anxiety and depression along with the patients.

Alarmed by such discoveries, doctors and administrators at about thirty-five U.S. hospitals have established post-ICU clinics, where teams of doctors, nurses, pharmacists, therapists (physical, occupational, cognitive, speech), and social workers screen for a host of conditions and help guide patients through them.

Vanderbilt’s clinic saw its first patient in 2012. The Critical Illness Recovery Center at the University of Pittsburgh Medical Center, which Butcher founded in 2018, works with about one hundred patients a year, including Masterson. Yale opened its clinic in 2022.

They rely on six practices recommended by the Society of Critical Care Medicine that are shown to significantly reduce post-ICU symptoms. The measures call for changes such as using lighter sedation, getting patients up and moving earlier, testing their breathing daily to wean them from ventilators sooner, and removing restrictions on family visiting.

Clinics often offer support groups for patients and families. There’s evidence that keeping an ICU diary, in which patients and caregivers record their experiences, and engaging in exercise and physical rehabilitation improve mental health after discharge.

Also on the clinics’ agenda: discussions of what other options patients might prefer if they face another critical illness, as many do. Would they agree to undergo intensive care and risk its aftereffects again? Or choose palliative care, which emphasizes comfort rather than cure? Some post-ICU patients remain permanently impaired.

Butcher, although he said that the use of the new practices needed to expand dramatically, sounded optimistic about the future of critical care. “We’re going to find better diagnostic tools, better preventive strategies, and better therapies,” he said.

For now, though, the ICU experience remains disorienting and sometimes traumatic. When Butcher asked 117 patients in his post-ICU clinic those next-time questions, many wanted to place limits on further medical interventions.

About a third would want to lower the level of aggressive care. Of those, about a quarter would want “do not resuscitate” and “do not intubate” orders, and almost 7% said they never wanted to return to an ICU.

Masterson is working hard to further his recovery. “I haven’t been out and about much,” he said. “I’ve been kind of homebound.” He hopes to get strong enough to resume running — he used to log three to four miles several times a week.

The future for patients contending with post-ICU syndrome often depends on their physical, mental, and cognitive health before their admission. Masterson’s previous fitness and cognitively demanding work bode well for his further progress, Butcher said.

His family remains alternatively hopeful and worried. “Down the road, what’s it going to be like?” Dedes, his brother-in-law, wondered. “We just take it day by day.”

The New Old Age is produced through a partnership with The New York Times.

Anemia is a common condition that can have serious medical consequences, but doctors often fail to recognize it. Journalist Paula Span investigates the situation here and has suggestions for patients. KFF Health News posted her column on July 17, 2025. It also ran in the New York Times. Funding from the Silver Century Foundation helps KFF Health News produce articles (like this one) on longevity and related health and social issues. 

Gary Sergott felt weary all the time. “I’d get tired, short of breath, a sort of malaise,” he said. He was cold even on warm days and looked pale with dark circles under his eyes.

His malady was not mysterious. As a retired nurse anesthetist, Sergott knew he had anemia, a deficiency of red blood cells. In his case, it was the consequence of a hereditary condition that caused almost daily nosebleeds and depleted his hemoglobin, the protein in red blood cells that delivers oxygen throughout the body.

But in consulting doctors about his fatigue, he found that many didn’t know how to help. They advised Sergott, who lives in Westminster, MD, to take iron tablets, usually the first-line treatment for anemia.

But like many older people, he found a daily regimen of four to six tablets hard to tolerate. Some patients taking iron complain of severe constipation or stomach cramps. Sergott felt “nauseated all the time.” And iron tablets don’t always work.

After almost fifteen years, he found a solution. Michael Auerbach, MD, a hematologist and an oncologist who is the co-director of the Center for Cancer and Blood Disorders in Baltimore, suggested that Sergott receive iron intravenously instead of orally.

Now Sergott, seventy-eight, gets an hourlong infusion when his hemoglobin levels and other markers show that he needs one, usually three times a year. “It’s like filling the gas tank,” he said. His symptoms recede, and “I feel great.”

His story reflects, however, the frequent dismissal of a common condition, one that can not only diminish older adults’ quality of life but also lead to serious health consequences, including falls, fractures and hospital stays.

One study found that 20 percent of nearly 2,000 people who were tested were anemic.

Anemia’s symptoms—tiredness, headaches, leg cramps, coldness, decreased ability to exercise, brain fog—are often attributed to aging itself, William Ershler, MD, a hematologist and researcher said. (Some people with anemia remain asymptomatic.)

“People say, ‘I feel weak, but everybody my age feels weak,’” Ershler said.

Even though hemoglobin levels are likely to have been included in their patients’ records, as part of the complete blood count, or CBC, routinely ordered during medical visits, doctors often fail to recognize anemia.

“The patients come to the clinic and get the blood tests, and nothing happens,” he said.

Anemia affects 12.5% of people over sixty, according to the most recent survey data from the National Health and Nutrition Examination Survey, and the rate rises thereafter.

But that may be an underestimate. In a study published in the Journal of the American Geriatrics Society, Ershler and his colleagues examined the electronic health records of almost 2,000 outpatients over sixty-five at Inova, the large health system based in Northern Virginia from which he recently retired.

Based on blood test results, the prevalence of anemia was much higher: about one in five patients was anemic,  with hemoglobin levels below normal as defined by the World Health Organization.

Yet only about a third of those patients had anemia properly documented in their medical charts.

One possible cause of anemia: blood loss, due to internal bleeding from ulcers, polyps, diabetes or other disorders.

Anemia “deserves our attention, but it doesn’t always get it,” said George Kuchel, MD, a geriatrician at the University of Connecticut, who wasn’t surprised by the findings.

That’s partly because anemia has so many causes, some more treatable than others. In perhaps a third of cases, it arises from a nutritional deficiency—usually a lack of iron—but sometimes of vitamin B12 or folate (called folic acid in synthetic form).

Older people may have decreased appetites or struggle to shop for food and prepare meals. But anemia can also follow blood loss from ulcers, polyps, diabetes and other causes of internal bleeding.

Surgery can also lead to iron deficiency. Mary Dagold, eighty-three, a retired librarian in Pikesville, MD, underwent three abdominal operations in 2019. She remained bedridden for weeks afterward and needed a feeding tube for months. Even after she healed, “the anemia didn’t go away,” she said.

She remembers feeling perpetually exhausted. “And I knew I wasn’t thinking the way I usually think,” she added. “I couldn’t read a novel.” Her primary care doctor and Auerbach both advised that oral iron was unlikely to help.

Iron tablets, available over the counter, are inexpensive. Intravenous iron, becoming more widely prescribed, can cost $350 to $2,400 per infusion depending on the formulation, Auerbach said.

Some patients find a single dose sufficient, while others will need regular treatment. Medicare covers it when tablets are hard to tolerate or ineffective.

For Dagold, a twenty-five-minute intravenous iron infusion every five weeks or so has made a startling difference. “It takes a few days, and then you feel well enough to go about your daily life,” she said. She has returned to her water aerobics class four days a week.

In about one-third of cases, the cause of the patient’s anemia is never pinned down. 

In other cases, anemia arises from chronic conditions like heart disease, kidney failure, bone marrow disorders or inflammatory bowel diseases.

“These people don’t lack iron, but they’re not able to process it to make red blood cells,” Kuchel said. Since iron supplements won’t be effective, doctors try to address the anemia by treating patients’ underlying illnesses.

Another reason to pay attention: “Loss of iron can be the first harbinger of colon cancer and stomach cancer,” Kuchel pointed out.

In about a third of patients, however, anemia remains frustratingly unexplained. “We’ve done everything, and we have no idea what’s causing it,” he said.

Learning more about anemia’s causes and treatments might prevent a lot of misery down the road. Besides its association with falls and fractures, anemia “can increase the severity of chronic illnesses—heart, lung, kidney, liver,” Auerbach said. “If it’s really severe and hemoglobin goes to life-threatening levels, it can cause a heart attack or stroke.”

Among the unknowns, however, is whether treating anemia early and restoring normal hemoglobin will prevent later illnesses. Still, “things are happening in this field,” Ershler said, pointing to a National Institute on Aging workshop on unexplained anemia held last year.

The American Society of Hematology has appointed a committee on diagnosing and treating iron deficiency and plans to publish new guidelines next year. The Iron Consortium at Oregon Health & Science University convened an international panel on managing iron deficiency and recently published its recommendations in The Lancet Haematology.

In the meantime, many older patients can gain access to their CBC results and thus their hemoglobin levels. The World Health Organization defines thirteen grams of hemoglobin per deciliter as normal for men, and twelve for nonpregnant women (though some hematologists argue that those thresholds are too low).

Asking health care providers about hemoglobin and iron levels, or using a patient portal to check the numbers themselves, could help patients steer conversations with their doctors away from fatigue or other symptoms as inevitable results of aging.

Perhaps they’re signs of anemia, and perhaps it’s treatable.

“Chances are, you’ve had a CBC in the last six months or a year,” Kuchel said. “If your hemoglobin is fine, great.”

But, he added, “If it’s really outside the normal boundaries, or it’s changed compared to a year ago, you need to ask questions.”

Let’s be clear: The primary reason to be vaccinated against shingles is that two shots provide at least 90% protection against a painful, blistering disease that a third of Americans will suffer in their lifetimes, one that can cause lingering nerve pain and other nasty long-term consequences.

The most important reason for older adults to be vaccinated against the respiratory infection RSV is that their risk of being hospitalized with it declines by almost 70% in the year they get the shot, and by nearly 60% over two years.

And the main reason to roll up a sleeve for an annual flu shot is that when people do get infected, it also reliably reduces the severity of illness, though its effectiveness varies by how well scientists have predicted which strain of influenza shows up.

But other reasons for older people to be vaccinated are emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.

The list of off-target benefits is lengthening as “the research has accumulated and accelerated over the last 10 years,” said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Some of these protections have been established by years of data; others are the subjects of more recent research, and the payoff is not yet as clear. The first RSV vaccines, for example, became available only in 2023.

Still, the findings “are really very consistent,” said Stefania Maggi, a geriatrician and senior fellow at the Institute of Neuroscience at the National Research Council in Padua, Italy.

She is the lead author of a recent meta-analysis, published in the British journal Age and Ageing, that found reduced risks of dementia after vaccination for an array of diseases. Given those “downstream effects,” she said, vaccines “are key tools to promote healthy aging and prevent physical and cognitive decline.”

Yet too many older adults, whose weakening immune systems and high rates of chronic illness put them at higher risk of infectious diseases, have not taken advantage of vaccination.

The Centers for Disease Control and Prevention reported last week that about 31% of older adults had not yet received a flu shot. Only about 41% of adults 75 and older had ever been vaccinated against RSV, or respiratory syncytial virus, and about a third of seniors had received the most recent covid-19 vaccine.

The CDC recommends the one-and-done pneumococcal vaccine for adults 50 and older. An analysis in the American Journal of Preventive Medicine, however, estimated that from 2022, when new guidelines were issued, through 2024, only about 12% of those 67 to 74 received it, and about 8% of those 75 and older.

The strongest evidence for off-target benefits, dating back 25 years, shows reduced cardiovascular risk following flu shots.

Healthy older adults vaccinated against flu have substantially lower risks of hospitalization for heart failure, as well as for pneumonia and other respiratory infections. Vaccination against influenza has also been associated with lower risks of heart attack and stroke.

Moreover, many of these studies predate the more potent flu vaccines now recommended for older adults.

Could the RSV vaccine, protective against another respiratory illness, have similar cardiovascular effects? A recent large Danish study of older adults found a nearly 10% decline in cardiorespiratory hospitalizations — involving the heart and lungs — among the vaccinated versus a control group, a significant decrease.

Lowered rates of cardiovascular hospitalizations and stroke did not reach statistical significance, however. That may reflect a short follow-up period or inadequate diagnostic testing, cautioned Helen Chu, an infectious disease specialist at the University of Washington and co-author of an accompanying editorial in JAMA.

“I don’t think RSV behaves differently from flu,” Chu said. “It’s just too early to have the information for RSV, but I think it will show the same effect, maybe even more so.”

Vaccination against still another dangerous respiratory disease, covid, has been linked to a lower risk of developing long covid, with its damaging effects on physical and mental health.

Probably the most provocative findings concern vaccination against shingles, aka herpes zoster. Researchers made headlines last year when they documented an association between shingles vaccination and lower rates of dementia — even with the less effective vaccine that has since been replaced by Shingrix, approved in 2017.

Nearly all studies of off-target benefits are observational, because scientists cannot ethically withhold a safe, effective vaccine from a control group whose members could then become infected with the disease.

That means such studies are subject to “healthy volunteer bias,” because vaccinated patients may also practice other healthy habits, differentiating them from those not vaccinated.

Although researchers try to control for a variety of potentially confounding differences, from age and sex to health and education, “we can only say there’s a strong association, not a cause and effect,” Maggi said.

But Stanford researchers seized on a natural experiment in Wales in 2013, when the first shingles vaccine, Zostavax, became available to older people who had not yet turned 80. Anyone who had was ineligible.

Over seven years, dementia rates in participants who had been eligible for vaccination declined by 20% — even though only half had actually received the vaccine — compared with those who narrowly missed the cutoff.

“There are no reasons people born one week before were different from those born a few days later,” Maggi said. Studies in Australia and the United States have also found reductions in the odds of dementia following shingles shots.

In fact, in the meta-analysis Maggi and her team published, several other childhood and adult vaccinations appeared to have such effects. “We now know that many infections are associated with the onset of dementia, both Alzheimer’s and vascular,” she said.

In 21 studies involving more than 104 million participants in Europe, Asia, and North America, vaccination against shingles was associated with a 24% reduction in the risk of developing dementia. Flu vaccination was linked to a 13% reduction. Those vaccinated against pneumococcal disease had a 36% reduction in Alzheimer’s risk.

The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for months. It was associated with a one-third decline in dementia.

Other researchers are investigating the effects of shingles vaccination on heart attacks and stroke and of covid vaccination on cancer survival.

What causes such vaccine bonuses? Most hypotheses focus on the inflammation that arises when the immune system mobilizes to fight off an infection. “You have damage to the surrounding environment” in the body, “and that takes time to calm down,” Chu said.

The effects of inflammation can far outlast the initial illness. It may allow other infections to take hold, or cause heart attacks and strokes when clots form in narrowed blood vessels. “If you prevent the infection, you prevent this other damage,” Chu said.

Hospitalization itself, during which older patients can become deconditioned or develop delirium, is a risk factor for dementia, among other health problems. Vaccines that reduce hospitalization might therefore delay or ward off cognitive decline.

Health officials in the Trump administration have assailed childhood vaccines more than adult ones, but their vocal opposition may be contributing to inadequate vaccination among older Americans, too.

Many will not only miss out on the emerging off-target benefits but will remain vulnerable to the diseases the vaccines prevent or diminish.

“The current national policy on vaccination is at best uncertain, and in instances appears anti-vaccine,” said Schaffner, a former member of the CDC’s Advisory Committee on Immunization Practices. “All of us in public health are very, very distressed.”

“The New Old Age” is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Year after year, Mary Bucklew strategized with a nurse practitioner about losing weight. “We tried exercise,” like walking thirty-five minutes a day, she recalled. “And 39,000 different diets.”

But five pounds would come off and then invariably reappear, said Bucklew, seventy-five, a public transit retiree in Ocean View, Delaware. Nothing seemed to make much difference — until 2023, when her body mass index slightly exceeded forty, the threshold for severe obesity.

“There’s this new drug I’d like you to try, if your insurance will pay for it,” the nurse practitioner advised. She was talking about Ozempic.

Medicare covered it for treating Type 2 diabetes but not for weight loss, and it cost more than $1,000 a month out-of-pocket. But to Bucklew’s surprise, her Medicare Advantage plan covered it even though she wasn’t diabetic, charging just a $25 monthly copay.

Pizza, pasta, and red wine suddenly became unappealing. The drug “changed what I wanted to eat,” she said. As twenty-five pounds slid away over six months, she felt less tired and found herself walking and biking more.

Then her Medicare plan notified her that it would no longer cover the drug. Calls and letters from her health care team, arguing that Ozempic was necessary for her health, had no effect.

With coverage denied, Bucklew became part of an unsettlingly large group: older adults who begin taking GLP-1s and related drugs — highly effective for diabetes, obesity, and several other serious health problems — and then stop taking them within months.

That usually means regaining weight and losing the associated health benefits, including lower blood pressure, cholesterol, and A1c, a measure of blood sugar levels over time.

Widely portrayed as wonder drugs, semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Zepbound, Mounjaro), and related medications have transformed the treatment of diabetes and obesity.

The FDA has approved several GLP-1s for additional uses, too — including to treat kidney disease and sleep apnea, and prevent heart attacks and strokes.

“They’re being studied for every purpose you can conceive of,” said Timothy Anderson, a health services researcher at the University of Pittsburgh and author of a recent JAMA Internal Medicine editorial about anti-obesity medications.

(Drug trials have found no impact on dementia, however.)

People sixty-five and older represent prime targets for such medications. “The prevalence of obesity hovers around 40%” in older adults, as measured by body mass index, said John Batsis, a geriatrician and obesity specialist at the University of North Carolina School of Medicine.

The proportion of people with Type 2 diabetes rises with age, too, to nearly 30% at age sixty-five and older. Yet a recent JAMA Cardiology study found that among Americans sixty-five and up with diabetes, about 60% discontinued semaglutide within a year.

Another study of 125,474 people with obesity or who are overweight found that almost 47% of those with Type 2 diabetes and nearly 65% of those without diabetes stopped taking GLP-1s within a year — a high rate, said Ezekiel Emanuel, a health services researcher at the University of Pennsylvania and senior author of the study.

Patients sixty-five and older were 20% to 30% more likely than younger ones to discontinue the drugs and less likely to return to them.

What explains this pattern? As many as 20% of patients may experience gastrointestinal problems. “Nausea, sometimes vomiting, bloating, diarrhea,” Anderson said, ticking off the most common side effects.

Linda Burghardt, a researcher in Great Neck, New York, started taking Wegovy because her doctor thought it might reduce arthritis pain in her knees and hips. “It was an experiment,” said Burghardt, seventy-nine, who couldn’t walk far and had stopped playing pickleball.

Within a month, she suffered several bouts of stomach upset that “went on for hours,” she said. “I was crying on the bathroom floor.” She stopped the drug.

Some patients find that medication-induced weight loss lessens rather than improves fitness, because another side effect is muscle loss. Several trials have reported that 35% to 45% of GLP-1 weight loss is not fat, but “lean mass” including muscle and bone.

Bill Colbert’s cherished hobby for fifty years, reenacting medieval combat, involves “putting on 90 pounds of steel-plate armor and fighting with broadswords.” A retired computer systems analyst in Churchill, Pennsylvania, he started on Mounjaro, successfully lowered his blood glucose, and lost 18 pounds in two months.

But “you could almost see the muscles melting away,” he recalled. Feeling too weak to fight well at age seventy-eight, he also discontinued the drug and now relies on other diabetes medications.

“During the aging process, we begin to lose muscle,” typically half a percent to 1% of muscle weight per year, said Zhenqi Liu, an endocrinologist at the University of Virginia who studies the effects of weight loss drugs. “For people on these medications, the process is much more accelerated.”

Losing muscle can lead to frailty, falls, and fractures, so doctors advise GLP-1 users to exercise, including strength training, and to eat enough protein.

The high rate of GLP-1 discontinuation may also reflect shortages; from 2022 to 2024, these drugs temporarily became hard to find. Further, patients may not grasp that they will most likely need the medications indefinitely, even after they meet their blood glucose or weight goals.

Re-initiating treatment involves its own hazards, Batsis cautioned. “If weight goes up and down, up and down, metabolically it sets people up for functional decline down the road.”

Of course, in considering why patients discontinue, “a large part of it is money,” Emanuel said. “Expensive drugs, not necessarily covered” by insurers. Indeed, in a Cleveland Clinic study of patients who discontinued semaglutide or tirzepatide, nearly half cited cost or insurance issues as the reason.

Some moderation in price has already occurred. The Biden administration capped out-of-pocket payments for all prescriptions that a Medicare beneficiary receives ($2,100 is the 2026 limit), and authorized annual price negotiations with manufacturers.

The reductions include Ozempic, Wegovy, and Rybelsus, though not until 2027. Medicare Part D drug plans will then pay $274, and since most beneficiaries pay 25% in coinsurance, their out-of-pocket monthly cost will sink to $68.50.

Perhaps even lower, if agreements announced in November between the Trump administration and drugmakers Eli Lilly and Novo Nordisk pan out.

The bigger question is whether Medicare will amend its original 2003 regulations, which prohibit Part D coverage for weight loss drugs. “An archaic policy,” said Stacie Dusetzina, a health policy researcher at the Vanderbilt University School of Medicine.

The Trump administration’s November announcement would expand Medicare eligibility for GLP-1s and related medications to include obesity, perhaps as early as spring. But key details remain unclear, Dusetzina said.

Medicare should cover anti-obesity drugs, many doctors argue. Americans still tend to think that “diabetes is a disease and obesity is a personal problem,” Emanuel said. “Wrong. Obesity is a disease, and it reduces life span and compromises health.”

But given the expense to insurers, Dusetzina warned, “if you expand the indications and extent of coverage, you’ll see premiums go up.”

For older patients, often underrepresented in clinical trials, questions about GLP-1s remain. Might a lower maintenance dose stabilize their weight? Can doses be spaced out? Could nutritional counseling and physical therapy offset muscle loss?

Bucklew, whose coverage was denied, would still like to resume Ozempic. But because of a recent sleep apnea diagnosis, she now qualifies for Zepbound with a $50 monthly copay.

She has seen no weight loss after three months. But as the dose increases, she said, “I’ll stay the course and give it a shot.”

The New Old Age is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.