If you are on medicare you do not pay it back with your assets, If you are on Medicaid you do pay it back with your assets. Medicaid is not insurance, it is welfare and it is paid back with assets.
Therefore all the people who signed up for Medicaid, ensured that they would give their assets over to the government if they need medical care. And that is how it will be paid.
To be fair, the states generally find out about estate assets only through probate hearings; if no hearing then no recovery. Also, states in many cases simply do not pursue for many reasons (staffing, small size of estate, legal complications, etc). My state fairly aggressively goes after Medicaid Estate Recovery yet brings in only about 17 million a year — not really that much.
The subsidies on exchange policies are every bit as much welfare as Medicaid.
I meant to reply to you as well: I meant to type Medicaid instead of Medicare.