They've lived with the health warnings about smoking for much of their lives and doubtless seen the ill effects on friends, relatives and even themselves, yet about 4.5 million older people in the U.S. keep on lighting up. Medicare is finally catching up to most private insurers by providing counseling for anyone on the program who's trying to kick the habit.
Dr. Barry Straube, Medicare's chief medical officer, says it's never too late to quit, even for lifelong smokers.
"The elderly can respond to smoking cessation counseling even if they have been smoking for 30 years or more," says Straube. "We do know we can see a reduction in the death rate and complications from smoking-related illnesses." Not only cancer, heart disease and lung problems, which can kill, but also gastric reflux, osteoporosis and other ailments that undermine quality of life.
Smoking-related illnesses cost Medicare tens of billions a year. Straube cites a two-decade estimate of $800 billion, from 1995 through 2015.
Medicare already covers drugs used to help smokers quit, as well as counseling for those who have developed a smoking-related illness. But starting immediately, the program will expand the benefit to cover up to eight counseling sessions a year for people who want to quit.
Next year, such counseling will be free, under a provision in President Barack Obama's health care law that eliminates co-payments for preventive services.
Older smokers often don't get as much attention from doctors as do younger ones. "They just figure, 'Well, it's too late,'" said Straube, that the damage is already done. That may start to change now.
About one in 10 seniors smoke, compared with one in five people among the U.S. population as a whole. It turns out that smokers age 65 and older present a medical paradox.
Many started when it was fashionable to light up. They are more likely than younger smokers to be seriously hooked on nicotine and less likely to attempt quitting. But research shows that their odds of success are greater if they do try to give up the habit.
Older smokers who receive counseling are significantly more likely to quit than those who only get standard medical care. One study of elderly heart attack patients found that those who got counseling to help quit smoking were more likely to be alive five years later.
It's unclear why older people who try to quit have better luck than younger smokers.
Some experts think it's because older smokers are more motivated, perhaps from having seen a loved one die of cancer or heart disease, or by recognizing how the cigarette habit has left its mark in their own bodies, anything from wrinklier skin to shortness of breath.
Straube has his own theory: "They're under less stress," he said. "They are not working anymore, and they have more time."
Medicare's new smoking cessation benefit will also be available to younger people who are covered by the program because of a disability. About 1 million of them are smokers.