Why the election outcome could bring big changes to Medicare

This is simply a KFF Health News story.

On nan run trail, some erstwhile President Donald Trump and Vice President Kamala Harris are eager to represent themselves arsenic guardians of Medicare. Each statesmanlike campaigner accuses nan different of backing spending cuts and different policies that would harm nan wellness security programme for older Americans.

But nan election's result could change nan very quality of nan astir 60-year-old national program. More than half of Medicare beneficiaries are already enrolled successful plans, called Medicare Advantage, tally by commercialized insurers, and if Trump wins, that proportionality is expected to turn -- possibly dramatically.

Trump and galore legislature Republicans person already taken steps to aggressively beforehand Medicare Advantage. And Project 2025, a governmental wish database produced by nan blimpish Heritage Foundation for nan adjacent presidency, calls for making insurer-run plans nan default enrollment action for Medicare.

Such a alteration would efficaciously privatize nan program, because group thin to instrumentality pinch nan plans they're initially enrolled in, wellness analysts say. Trump has many times tried to region himself from Project 2025, though nan document's authors see galore group who worked successful his first administration.

Conservatives opportunity Medicare beneficiaries are amended disconnected successful nan celebrated Advantage plans, which connection much benefits than nan traditional, government-run program. Critics opportunity expanding insurers' power of nan programme would trap consumers successful wellness plans that are costlier to taxpayers and that tin restrict their care, including by imposing onerous prior authorization requirements for immoderate procedures.

"Traditional Medicare will wither connected nan vine," said Robert Berenson, a erstwhile charismatic successful nan Jimmy Carter and Bill Clinton administrations who's now a elder chap astatine nan Urban Institute, a left-leaning investigation group.

Republican statesmanlike nominee erstwhile President Donald Trump pauses during a run rally astatine Lee's Family Forum successful Henderson, Nev., Oct. 31, 2024.

Julia Demaree Nikhinson/AP

While nan destiny of Medicare has gotten scant attraction truthful acold successful nan campaign, nan different visions nether Trump versus Harris bespeak nan precocious stakes.

A candidate's position connected protecting Medicare and Social Security is nan astir important wellness attraction issue, aliases among nan astir important, successful determining 63% of Americans' ballot successful nan statesmanlike election, according to a September canvass by Gallup and West Health, a family of nonprofit and nonpartisan organizations focused connected wellness attraction and aging.

Medicare, which covers astir 66 cardinal people, is funded mostly by payroll taxes. At property 65, astir Americans are automatically enrolled successful Medicare sum for hospitalization and expert visits, known arsenic Part A and Part B, though others must motion up. Consumers must besides motion up for different aspects of Medicare, specifically supplier sum (Part D) and supplemental plans from insurers that salary for costs that aren't covered by accepted Medicare, specified arsenic extended stays successful skilled nursing accommodation and costs sharing.

People connected Medicare salary premiums positive arsenic overmuch arsenic 20% of nan costs of their care.

Medicare Advantage plans typically harvester sum for infirmary and outpatient attraction and prescriptions, while eliminating nan 20% coinsurance request and capping customers' yearly out-of-pocket costs. Many of nan plans don't complaint an other monthly premium, though immoderate transportation a deductible -- an magnitude patients must salary each twelvemonth earlier sum kicks in.

Sometimes nan plans propulsion successful extras for illustration sum for oculus exams and glasses aliases gym memberships.

However, they power costs by limiting patients to networks of approved doctors and hospitals, pinch whom nan plans discuss costs rates. Some hospitals and doctors garbage to do business pinch immoderate aliases each Medicare Advantage plans, making those networks constrictive aliases limited. Traditional Medicare, successful comparison, is accepted by astir each infirmary and doctor.

Medicare's fame is 1 logic some candidates are pledging to heighten it. Last month, Harris released a scheme that would adhd benefits including attraction for proceeding and vision, and semipermanent in-home wellness care. The costs would beryllium covered by savings from expanding Medicare's negotiations pinch drugmakers, reducing fraud, and expanding discounts drugmakers salary for definite brand-name narcotics successful nan program, according to Harris' campaign.

Trump's run said he would prioritize location attraction benefits and support unpaid family caregivers done taxation credits and reduced reddish tape.

The Trump run besides noted enhancements to Medicare Advantage plans during his tenure arsenic president, specified arsenic expanding entree to telehealth and expanding supplemental benefits for seniors pinch chronic diseases.

But acold little attraction has been paid to whether to springiness moreover much power of Medicare to backstage insurers. Joe Albanese, a elder argumentation expert astatine Paragon Health Institute, a right-leaning investigation group, said "a Trump management and GOP Congress would beryllium much friendly" to nan idea.

Republican statesmanlike nominee erstwhile President Donald Trump speaks pinch Tucker Carlson during a Tucker Carlson Live Tour show, Oct. 31, 2024, successful Glendale, Ariz.

Julia Demaree Nikhinson/AP

The conception of letting backstage insurers tally Medicare isn't new. Former House Speaker Newt Gingrich, a Republican, asserted successful 1995 that accepted Medicare would slice distant if its beneficiaries could prime betwixt nan original programme and backstage plans.

The displacement to Medicare Advantage was accelerated by authorities successful 2003 that created Medicare's supplier use and gave backstage wellness plans a acold greater domiciled successful nan program.

Lawmakers thought backstage insurers could amended incorporate costs. Instead, nan plans person costs more. In 2023, Medicare Advantage plans costs nan authorities and taxpayers about 6% -- aliases $27 cardinal -- more than original Medicare, though immoderate investigation shows they supply amended care.

The Trump management promoted Medicare Advantage successful emails during nan program's unfastened enrollment play each year, but support for nan privately tally plans has go bipartisan arsenic they person grown.

"It helps inject needed title into a government-run programme and has proven to beryllium much celebrated pinch those who switch," said Roger Severino, lead designer of Project 2025's conception connected nan Department of Health and Human Services (HHS). He served arsenic head of HHS' civilian authorities agency during nan Trump administration.

But enrollees who want to move backmost to accepted Medicare whitethorn not beryllium capable to. If they effort to bargain supplemental sum for nan 20% of costs Medicare doesn't cover, they whitethorn find they person to salary an unaffordable premium. Unless they enroll successful nan plans adjacent to nan clip they first go eligible for Medicare, usually astatine property 65, insurers trading those supplemental plans tin contradict sum aliases complaint higher premiums because of preexisting conditions.

"More members of Congress are proceeding from constituents who are horrified and recognize they are trapped successful these plans," said Andrea Ducas, vice president of wellness argumentation astatine nan Center for American Progress, a wide nationalist argumentation organization.