For Immediate Release | March 4, 2020


Bethany Cole (202) 243-7009 or

A report from the nonpartisan National Academy of Social Insurance unpacks the significant set of technical and program design challenges facing proposals, by presidential candidates and other policymakers, to expand Medicare. The Academy’s new study, Examining Approaches to Expand Medicare Eligibility: Key Design Options and Implications, analyzes and compares three approaches:

  • lowering the Medicare eligibility age by just a few years to age 62 or to as low as age 50;
  • extending Medicare coverage to all;
  • creating a buy-in under which some or all of the population or employers would be eligible to purchase Medicare or Medicare-like coverage.

According to the study, “three policy goals are among the most commonly presented by advocates of reforms involving Medicare eligibility changes: expanding coverage; increasing the affordability of coverage and care; and containing costs. Delivering on these policy goals simultaneously is not necessarily possible and may entail tradeoffs.”

These policy goals serve as a framework for the study along with key design decisions including:

  • eligibility criteria;
  • benefit structure, including covered services and cost sharing;
  • premium structure and whether subsidies are available for newly eligible populations;
  • provider payment rates and regulations concerning provider participation;
  • the roles of Medicare Advantage and private supplemental coverage;
  • financing mechanisms;
  • the rules regulating interactions with other public and private insurance;
  • rules governing the transition to a new or modified program.

“As the nation explores a wide range of policy options addressing the health care needs of all Americans, Medicare is at the center of many proposals,” said Cori Uccello, Co-Chair of the 27-member interdisciplinary Study Panel that developed the report over 10 months of deliberation. “We hope that the findings in this report will increase understanding of Medicare-based approaches, and be used by researchers, journalists, policymakers, and other audiences to analyze and design feasible policy options,” said Marilyn Moon, Co-Chair of the Study Panel.

The full report, along with an Executive Summary and additional resources, may be downloaded from the Academy’s website:

Since the National Academy of Social Insurance was founded in 1986, it has provided rigorous inquiry and insights into the functioning of our nation’s social insurance programs – Social Security, Medicare, Unemployment Insurance, and Workers’ Compensation. Now comprised of over 1,000 of the nation’s top experts in social insurance and related policies and programs, the Academy studies how social insurance can continue to meet the changing needs of American families, employees, and employers. The Academy also looks at new frontiers for social insurance, including areas of uninsured or underinsured economic risks and related policies. To learn more about the Academy’s work, please visit, or follow @socialinsurance on Twitter.

See related news: Medicare and Health Policy

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