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Examining Approaches to Expand Medicare Eligibility: Key Design Options and Implications

By: Elizabeth Docteur, Renée M. Landers, Bethany Cole, Marilyn Moon, and Cori Uccello
Published: March 2020

Improving access to affordable, high-quality health coverage and care and containing health care spending remain formidable policy challenges for the United States. Some policymakers and analysts view Medicare as a useful platform for expanding coverage because it has broad popularity, serves as a cost-effective source of health insurance coverage, and has potentially positive side effects across other parts of the health care system. Proposals to expand Medicare eligibility present, however, an extensive set of technical and program design considerations.

To address the lack of specificity in many proposals, the National Academy of Social Insurance formed the Study Panel on Medicare Eligibility to examine the options for and implications of extending eligibility for Medicare beyond the current covered populations. Composed of 27 members, the Study Panel brought together expertise and experience from a broad range of perspectives, such as economics, health policy, political science, sociology, medicine, and law, as well as people with direct experience working in areas related to public and private health insurance, including actuaries, health plan administrators, health care providers, labor representatives, and government regulators.

The report examines three approaches to changing Medicare eligibility: lowering the eligibility age, establishing Medicare-for-all, and creating a Medicare buy-in. Variants of these approaches could be designed to address key policy objectives, including expanding coverage, improving the affordability of access and care, and containing health care costs. The report aims to help policymakers and the public understand potential impacts as expansion options continue to be considered and debated.

 

Download the full report

Download a primer on Medicare

Download the Executive Summary

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The Academy gratefully acknowledges the work of the individuals who served on the Study Panel—especially its Co-Chairs Marilyn Moon and Cori Uccello—and the researchers who assisted with its writing. The Academy also thanks the Commonwealth Fund, Arnold Ventures, the Buffin Foundation, the AFL-CIO, the International Brotherhood of Teamsters, and the University of Maryland for their support of the Study Panel’s work.