Rep. Pramila Jayapal and more than 40 House Democrats have introduced a bill – the Improving Medicare Coverage Act – that would open Medicare to people as young as 50. If it became law, as many as 60 million more Americans could get their coverage through a program that has served older people for six decades.
That would be a remarkable achievement, and the sponsors deserve credit for proposing it. For people in their 50s and early 60s, the years before Medicare are often the hardest years to find and keep affordable coverage. A layoff, a divorce or a new diagnosis can leave someone priced out of the individual market or stuck in a high-deductible plan they can’t afford to use. Giving these people the option of Medicare would change lives.
Anyone who has spent time with the Medicare program as it works today knows, of course, that the devil is in the details. Medicare in 2026 is not the program it was in 1965, or even in 2005. More than half of the people enrolled now get their benefits through a private Medicare Advantage plan rather than traditional Medicare. Whether a bigger Medicare actually delivers better care at lower cost depends on which Medicare people would be joining.
Here are some questions that will need thoughtful answers as this bill moves forward in Congress:
What happens to Medicare Advantage?
Millions of people in Medicare Advantage plans run into prior authorization requirements, narrow networks and denials of care their doctors say they need. Federal investigators have documented Medicare Advantage insurers delaying and denying services that should have been covered. Bringing tens of millions of younger people into Medicare without fixing these problems would hand the insurers a huge new pool of customers and leave enrollees facing the same roadblocks.
The legislation should either eliminate Medicare Advantage or overhaul it so insurers can no longer inappropriately delay and deny care. If Medicare Advantage stays, Congress also has to fix how the government pays these plans. Taxpayers now overpay Medicare Advantage insurers by tens of billions of dollars a year. Expanding the program without fixing the payment system would only make those overpayments bigger.
What happens to traditional Medicare?
Traditional Medicare lets people see any doctor or hospital that takes Medicare, without prior authorization for most services. But it has two big gaps. It has no cap on out-of-pocket costs, and it doesn’t include prescription drug coverage. People who want that protection have to buy a Medigap supplemental policy and a separate Part D drug plan. In most states, Medigap insurers can turn people down or charge them more because of their health if they don’t buy a policy when they first become eligible.
For traditional Medicare to be a real option for a 50-year-old, it needs an out-of-pocket cap and drug coverage folded in. Without them, many people would be pushed into Medicare Advantage simply because they can’t afford the alternative.
How will people avoid the bad actors?
If Medicare Advantage plans are allowed to continue, people need a way to tell which plans deliver the care they promise and which ones don’t. That information is hard to come by today. Insurers are supposed to submit encounter data showing the services their enrollees actually receive, but the data they turn over is often incomplete, inaccurate or years old.
The bill should require insurers to provide complete, accurate and timely encounter data. With it, regulators, researchers and consumers could compare plans side by side, and people could steer clear of the insurers that serve them poorly.
What about everyone under 50?
Lowering the Medicare age would help people between 50 and 64, but about 145 million adults under 50 would still face the country’s affordability crisis. That includes some 20 million people with no insurance at all. Tens of millions more are underinsured, meaning they have coverage but can’t afford the deductibles and copays that come with it.
How will doctors and hospitals be paid?
Adding as many as 60 million people to Medicare would change the finances of doctors and hospitals across the country. Medicare generally pays providers less than commercial insurers do. The legislation will need to ensure that physicians and hospitals are paid appropriately, so they keep seeing Medicare patients and people can get the care they need when they need it.
Questions that remain
Many other questions are still unanswered. One of the biggest is what happens to prescription drug costs, both for people with Medicare and for everyone else. Another is how long the expansion would last. As introduced, most of the bill’s provisions would expire five years after they take effect.
The good news is that dozens of Democrats in the House are thinking about important foundational improvements to our health care system and recognize the value of public insurance. Lowering the Medicare age to 50 is a goal worth fighting for. Getting the details right will determine whether the people who gain Medicare also gain the affordable, reliable care they were promised.
