A new entrant in the current ongoing health reform debate (although similar concepts were discussed during earlier health reform debates), Medicare by Choice, has been floated by a group of former Congressional staffers and health care experts. It is expected to be a key plank in the Democrats’ 2028 presidential campaign and will likely get some play in the upcoming 2026 mid-term elections.
Medicare by Choice, as envisioned in this proposal, would allow employers to offer to their employees enrollment in Medicare as a health insurance option. It would open Medicare to individuals of any age. The proposal would also add an out-of-pocket cost cap, and dental, vision, and hearing benefits to Medicare. It would also simplify enrollment in Medicare by combining Medicare Parts A, B and D into just one health insurance program.
On financing, the proposal would separate existing age-based Medicare coverage and keep its trust funds separate from those buying into Medicare regardless of age, whether an employer-provided benefit or individually. “So, beneficiaries who are buying into Medicare through this program will be paying premiums that are calculated to keep the program financially solvent. So, they will be kind of siloed in financing,” said Center for Health and Democracy (CHD) executive director Rachel Madley. CHD is the sponsor of this proposal. Madley also said that Medicare by Choice is “a potential solution to the Medicare solvency issue, as it could drive more people to enroll in traditional Medicare as opposed to Medicare Advantage.”
Madley, a former Hill health care staffer, added, “What we’re trying to do here is find a path forward from the Affordable Care Act enhanced premium subsidy debate, now that those have expired, and find something that in 2028 can kind of unite folks behind it.”
Prospects: While Medicare by Choice is likely to play at least a background role in the current health reform debate, it has not immediately picked up support from the Medicare for All contingent (mostly Democrats) and ultimately may fall short of winning the support it would need to be seriously considered as a legislative proposal.
NAIFA Staff Contact: Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org