H.R. 3467 Could Mandate Automatic Enrollment and Lock-In for Medicare Advantage

The proposed H.R. 3467 legislation introduces automatic enrollment into the Medicare Advantage plan with the lowest premium starting January 1, 2028, for individuals entitled to Medicare Part A and enrolled in Part B. This measure would affect new Medicare eligibles, including those under 65 due to disability and those turning 65 during their Initial Enrollment Period. While automatic enrollment may simplify the process amid the complexity of Medicare, it raises significant issues related to limited plan network access, varied drug coverage, and differing out-of-pocket costs, as plans vary substantially beyond just premium price.

The bill's provision of a three-year lock-in period where enrollees cannot switch plans or revert to traditional fee-for-service Medicare except under specific hardship exceptions is a central concern. This lock-in could pose challenges if plan benefits, networks, or costs change, potentially impacting access to preferred providers or necessary medications. This restriction aims to stabilize care to improve enrollee health but may reduce patient autonomy and adaptability.

Additionally, opting out after automatic enrollment might be hindered by lack of awareness or procedural complexities, as low opt-out rates have been observed in similar contexts. The proposed implementation coincides with ongoing scrutiny of Medicare Advantage's costs and care practices, highlighting the tension between cost-saving initiatives and expanding Medicare Advantage enrollment.

Though still a proposal with a distant effective date, H.R. 3467's implications for Medicare beneficiaries and the insurance market are significant. It reflects an increased legislative push to favor Medicare Advantage, which currently incurs higher Medicare spending and presents known challenges in care approvals. Stakeholders have time to influence the legislative process to safeguard beneficiary choice and maintain flexibility in Medicare plans.