What Project 2025’s Potential Medicare Changes Mean for You | Global News Avenue

Medicare is one of the most important components of federal spending, so it’s no surprise that Project 2025, President-elect Donald Trump’s conservative blueprint for his second term, proposes several changes to the federal health insurance program for seniors. . The ideas aim to reduce the government’s roughly $850 billion in annual Medicare spending and increase efficiency through greater competition, privatization and transparency. They would make Medicare Advantage the default option for enrollees, change how providers are paid, and end the government’s drug price negotiation program.

Project 2025 Medicare Goals

Project 2025 was created by the Heritage Foundation, a long-established conservative think tank. It is nearly 900 pages long and contains proposals to reform every aspect of the federal government, including Medicare. The section on the Department of Health and Human Services, including Medicare, is written by Roger Severino, who served as director of the department’s Office for Civil Rights under Trump.

The plan begins by laying out four goals for Medicare:

1. Increase beneficiaries’ control over their health care
2. Reduce the regulatory burden on doctors
3. Ensure sustainability and value for beneficiaries and taxpayers
4. Reduce waste, fraud and abuse

How the 2025 plan will change Medicare

Severino proposed a series of administrative and legislative reforms to achieve these goals. Here’s how they impact consumers.

Make Medicare Advantage your default enrollment option

The most important proposal is to make Medicare Advantage the default insurance option. it has been better than original medical insurance54% of Medicare beneficiaries are enrolled in a Medicare Advantage plan. Since 2010, the number of people enrolled in Medicare Advantage has more than doubled.

But making it the default option would be complicated and require congressional changes social security lawsaid Rachel Schmidt, a research professor at Georgetown University’s McCourt School of Public Policy. This requires the government to determine how much the changes will cost and how they will be implemented, a process that could take months or longer.

“There are a lot of issues to consider, such as whether people currently on traditional Medicare will be grandfathered in or allowed to stay, what to do if a beneficiary doesn’t choose an MA plan right away, and how to assign them to a plan if or the beneficiary How to choose traditional health insurance, whether people enrolled in a plan that doesn’t have a provider in-network have the option to change plans, etc.,” Schmidt said.

Project 2025 also proposes changes to how Medicare Advantage plans are paid. Currently, insurance companies are paid based on complex formulas that take into account quality ratings, the health status of patients covered by the insurance company and other factors. But Severino wants to replace it with a competitive bidding model. Project 2025 doesn’t go into detail about the model, but in a proposal from researchers at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Centers for Medicare and Medicaid Services (CMS) Standards will be set for plan benefits, and companies will bid to deliver them. The proposal’s creators say it would increase competition and lower costs for consumers.

Repeal the Inflation Reduction Act

2025 plan calls for repeal Inflation reduction method and the Medicare Shared Savings Plan. IRA made several Medicare changesinclude:

• Limit insulin costs to $35 per month
• Annual out-of-pocket prescription drug costs are capped at $2,000
• Allow Medicare to negotiate drug prices with drug manufacturers

Severino called these policies “government price controls” that “limit access to drugs and reduce patient access to new medicines.”

However, it’s unclear how much support his ideas on drug price negotiations have in the new administration. An overwhelming majority of Americans (85%) support allowing the government to negotiate drug prices for people on Medicare. Robert F. Kennedy Jr., Trump’s nominee for health and human services secretary, wrote that “lawmakers should cap drug prices so that companies cannot charge Americans much more than Europeans” cost.”

The Inflation Reduction Act also eliminated the so-called “inflation” policies of the past. “Donut Hole” or coverage gap Medicare Part Dannual out-of-pocket prescription drug costs are capped at $2,000. Once you reach that limit, you enter catastrophic coverage. As a result of the IRA, Part D insurers will cover 60% of the costs during the catastrophic phase through 2025, while drug manufacturers and Medicare will each cover 20%.

Project 2025 recommends that manufacturers shoulder more costs at the catastrophic drug coverage level, which could save the government money.

site neutral payment

Currently, Medicare pays more for inpatient care than for care in doctors’ offices and other outpatient settings. Site-neutral payments would change that, giving outpatient providers the same funding as hospitals. This saves patients and Medicare money, since hospitals are often the most expensive places to receive health care.

Opponents say the changes will hurt hospitals’ finances and force them to scale back services. “The hospital industry is clearly totally opposed to it,” said Gerald Anderson, a professor at the Johns Hopkins Bloomberg School of Health.

‘Breakthrough’ medical device

Project 2025 is calling on the incoming administration to reinstate a rule called Medicare Coverage with Innovative Technologies that was repealed by the Biden administration before it took effect in 2021. The rule would give Medicare beneficiaries faster access to “breakthrough” medical devices, which would be covered by Medicare after the Food and Drug Administration approves them in an expedited program.

The Biden administration reversed the policy in November 2021, saying the devices could pose unknown or unexpected risks. Because it’s a federal rule and not a law, Trump can roll it back without input from Congress, although in most cases the government must provide notice and comment to the public about the proposal.

“If the Trump administration decides to pass this bill based on his agency leadership nominations, I can’t think of anyone who would oppose him in a way that might affect the outcome,” said researcher Leila Sullivan, a Georgetown University professor. Center on Health Insurance Reform at the Court School of Public Policy.