Trump Administration Pushes to Make Medicare Advantage Default for All Enrollees

The Trump administration is reportedly advancing plans to make Medicare Advantage (MA), a privatized Medicare option, the default enrollment for all Medicare beneficiaries. This shift represents a significant policy change from the traditional Medicare model where enrollees must actively choose MA plans. The CMS Innovation Center, under the direction of the administration, is exploring ways to implement this change possibly through waivers of statutory provisions designed to safeguard beneficiary choice.

Historically, the Trump administration has supported and expanded Medicare Advantage, increasing payments to MA plans and relaxing regulations, which contributed to a 31% growth in MA enrollment during his previous term. The current CMS leadership continues to promote privatization, with proposals that could require all Medicare enrollees, including dual-eligible individuals, to join managed care plans in select pilot regions.

This proposed default enrollment in MA plans raises concerns about limiting beneficiary choice and exposing enrollees to restrictive provider networks and prior authorization requirements not typically encountered in traditional Medicare. Evidence indicates that MA plans do not necessarily provide higher quality care, and in specific areas like access to top cancer hospitals, MA enrollees may experience disadvantages.

From a fiscal perspective, Medicare Advantage is more costly to taxpayers than traditional Medicare. MA plans are projected to cost the government at least $84 billion more this year alone. Expanding default enrollment to MA could escalate these costs dramatically, with estimates suggesting up to $2 trillion in excess spending over the next decade if MA enrollment rises to 75%.

The move toward full privatization of Medicare could significantly alter the benefits landscape and the financial sustainability of the program. Both beneficiary protections and cost containment measures are at risk if MA becomes the default option rather than a voluntary choice. Congressional intervention is suggested to preserve the traditional Medicare option and mandate explicit consent for MA enrollment to maintain program integrity and beneficiary autonomy.