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Most Americans become eligible for Medicare at age 65, but choosing how to enroll isn’t always straightforward.
That’s why a policy now under consideration could have outsized consequences. Trump administration officials say they are exploring whether to automatically enroll seniors into Medicare Advantage plans, instead of traditional Medicare, if they don’t actively choose a coverage option (1).
Today, people who don’t make a selection are defaulted into traditional Medicare. Shifting that default to Medicare Advantage (which is run by private insurers) could quietly steer millions of beneficiaries into a different type of coverage without them realizing it.
While the proposal is still in early stages, the change could affect everything from monthly costs to which doctors you can see and how easily you can switch plans later.
Under current rules, people who sign up for Medicare but don’t actively choose a plan are automatically enrolled in traditional Medicare.
The proposal under consideration would flip that system. Instead of defaulting into traditional Medicare, seniors who don’t make a selection could be automatically enrolled in a Medicare Advantage plan — the privately run version of Medicare offered by insurance companies.
As Medicare director Chris Klomp noted at a STAT News summit in March, regulators are looking into models that would either automatically enroll beneficiaries into the private form of Medicare or accountable care organizations, including those participating in the Medicare Shared Savings Program (2).
That shift may sound technical, but defaults carry real weight. Many people don’t fully compare their options or may feel overwhelmed by the number of plans and end up sticking with whatever they’re assigned. A change in the default could move large numbers of beneficiaries into Medicare Advantage without their active consent.
While some proposals would allow people to opt out, that process isn’t always simple.
A bill introduced in Congress would not only switch the default to Medicare Advantage, but also limit a person’s ability to leave their plan for up to three years once enrolled (3). That would make it harder for seniors to switch if their coverage doesn’t meet their needs.
