Trump Plan Would Auto-Enroll Seniors in Medicare Advantage

The Trump administration is actively considering a policy that would fundamentally change how Americans enter Medicare — by making private Medicare Advantage plans the automatic default for newly eligible beneficiaries, rather than Original Medicare. This would represent the most significant structural shift in Medicare enrollment since the program was created in 1965, and it carries real consequences for what doctors you can see, what you pay out of pocket, and how your care is managed from day one of eligibility.

Under the current system, when you turn 65 or qualify for Medicare through disability, you are automatically enrolled in Original Medicare — the federal government's fee-for-service program covering hospital care under Part A and outpatient services under Part B. If you want a Medicare Advantage plan instead, you have to actively choose one during your Initial Enrollment Period, which spans seven months: three months before your birthday month, your birthday month itself, and three months after. The proposed change would flip that default: you would be automatically placed into a Medicare Advantage plan and would need to actively opt out if you wanted to stay in Original Medicare.

This matters enormously because defaults are powerful. Research consistently shows that most people stick with whatever option they are automatically placed into, even when alternatives are available. If the default becomes Medicare Advantage, a large share of new enrollees may end up in private managed-care plans without fully understanding what that means for their coverage. Medicare Advantage plans — offered by private insurers like UnitedHealthcare, Humana, Aetna, and Blue Cross Blue Shield affiliates — operate very differently from Original Medicare. They typically use provider networks, meaning you may need to see doctors and hospitals within a specific list. They often require prior authorization before you can receive certain procedures or specialist visits. And while many plans in 2025 advertised $0 monthly premiums, the actual cost-sharing structure — copays, coinsurance, and out-of-pocket maximums — can vary dramatically from plan to plan and year to year.

The financial stakes are significant. In 2025, the average Medicare Advantage out-of-pocket maximum for in-network services was approximately $5,000 to $6,700 per year, though some plans set limits as high as $8,850 for in-network care and higher still when out-of-network costs are included. Original Medicare, by contrast, has no out-of-pocket maximum at all — which is why most beneficiaries in traditional Medicare pair it with a Medigap supplemental policy. A Medigap Plan G, one of the most comprehensive options available to new enrollees today, typically costs between $100 and $200 per month depending on your age, location, and the insurer, but it can cover most of the cost-sharing gaps that Original Medicare leaves behind. If new enrollees are defaulted into Medicare Advantage without understanding this landscape, they may miss their best window to purchase Medigap coverage with guaranteed issue rights — a window that does not come back easily.

That Medigap timing issue is one of the most underappreciated consequences of this proposal. Federal law gives you a six-month Medigap Open Enrollment Period starting the month you are both 65 or older and enrolled in Medicare Part B. During that window, insurers cannot deny you a Medigap policy or charge you more based on your health history. Once that window closes, insurers in most states can use medical underwriting — meaning they can reject you or charge significantly higher premiums if you have conditions like diabetes, heart disease, or a history of cancer. If a senior is defaulted into Medicare Advantage and later decides they want to switch to Original Medicare with a Medigap supplement, they may find themselves locked out of affordable Medigap coverage unless they live in one of the states that provides additional protections. California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, and Oregon all have birthday rules or other guaranteed issue windows that allow beneficiaries to switch Medigap plans without medical underwriting under certain circumstances — but even those protections have limits and do not fully replicate the original open enrollment window.

Proponents of the default Medicare Advantage approach argue that MA plans have grown substantially in popularity — enrollment surpassed 33 million beneficiaries in 2024, representing more than half of all Medicare enrollees — and that many plans offer extra benefits like dental, vision, and hearing coverage that Original Medicare does not provide. The Trump administration and some Republican lawmakers have framed the shift as a way to modernize Medicare and potentially reduce federal spending, since the government pays private insurers a per-member monthly rate to cover MA enrollees. However, independent analyses from the Medicare Payment Advisory Commission (MedPAC) have repeatedly found that the federal government actually pays Medicare Advantage plans more per beneficiary than it would cost to cover those same people under Original Medicare — an overpayment that has been estimated at billions of dollars annually.

Critics of the proposal, including patient advocacy organizations and some healthcare policy researchers, raise concerns about prior authorization burdens, network restrictions, and care denials. The Office of Inspector General and independent researchers have documented cases where Medicare Advantage plans denied care that would have been covered under Original Medicare. A 2022 OIG report found that 13 percent of prior authorization denials in Medicare Advantage were for services that met Medicare coverage rules and should have been approved. For a newly eligible 65-year-old who is automatically placed into an MA plan without understanding these dynamics, navigating a denial during a health crisis can be overwhelming.

If this policy moves forward, the most important action for anyone approaching Medicare eligibility is to treat the enrollment process as an active decision, not a passive one. Do not assume the plan you are placed into is the right fit. During your Initial Enrollment Period, compare your local Medicare Advantage options on Medicare.gov's Plan Finder tool, which allows you to enter your specific prescriptions and preferred doctors to see estimated annual costs. If you have a complex medical history, see specialists regularly, or travel frequently, Original Medicare with a Medigap supplement may offer broader access and more predictable costs. If you are generally healthy and want extra benefits like dental or vision, a well-rated Medicare Advantage plan may serve you well — but read the Evidence of Coverage document carefully before enrolling, paying particular attention to the prior authorization requirements and the provider network.

As of April 2026, this proposal has not been finalized or enacted into law. CMS would need to issue formal rulemaking — including a public comment period — before any default enrollment change could take effect. Beneficiaries and their families should monitor updates from CMS.gov and Medicare.gov, and anyone with specific questions about their own enrollment options can call 1-800-MEDICARE (1-800-633-4227) or contact their State Health Insurance Assistance Program (SHIP) counselor for free, unbiased guidance. SHIP counselors are available in every state and can walk you through plan comparisons without any financial interest in what you choose.