Medicare For All Who Want It

One of the hottest topics right now is the Medicare buy-in programs that are flying around Washington. We can all agree that it benefits our country to get health care access to all.

To make that a reality, some lawmakers have plans detailing their ideas.

Medicare buy-in gives protection to people who can afford the premium. Also, it helps to ease some of the costs Medicaid pays.

Three Medicare for All Buy-In Proposals

Medicare Buy-In ProgramsMedicare for All” plans include similar benefits with various funding options.

Most importantly the plans provide coverage for medically important services; including dental and vision while banning balance billing.

Next, they introduce a national fee schedule and a global budget.

The global budget would decide the amount of money available to refund hospitals, doctors, and clinics nationwide.

Medicare for all offsets the removal of current spending, employer programs, and ACA subsidiaries.

Although, either one could replace all sources of private and public health coverage with cost-sharing by the beneficiary.

Bernie Sanders Medicare for All Bill

Senator Sanders says his bill allows doctors and patients to negotiate private contracts. Also, Long term care would have coverage through Medicaid.

Use payment rates to create a fee schedule and a process for updating those rates. However, the public plan would provide coverage for reproductive health including abortion.

Effectively repealing the Hyde Amendment; which forbids taxpayer funds from paying for abortions except in cases of rape, incest, or to save the woman’s life.

Establish an Ombudsman to help the Secretary of Health and Human Services with complaints, and to identify issues with payments or coverages.

4-year phase-in period with subsidies that would add dental, vision, and an out of pocket maximum to beneficiary cost-sharing.

Ellison Bill

Keith Ellison’s bill includes long term services. Also, it prevents for-profit hospitals, facilities, and doctors from joining in the Medicare program.

Negotiate a fee schedule between State/Regional directors and providers. The schedule must have the approval of the Medicare director.

Those 18 and under would first receive a Universal Medicare Card. Then, those with employer coverage would transition to Medicare; the company would pay higher taxes instead of paying for the cost of private plans.

Elizabeth Warren Medicare For All Plan

We all know Medicare for All is going to cost trillions of dollars. Elizabeth Warren released her Medicare For All plan explaining the funding for this mass coverage.

Previously she was talking about creating a tax on the wealth of the richest in American to finance student debt cancellation and universal childcare.

Ms. Warren has said she is with Bernie on Medicare for all; however, Sanders openly admits that taxes will increase for the middle class.

Elizabeth says she won’t sign a bill that doesn’t lower costs for middle-class families.

Three Federal Public Plan Proposals

The three Federal Public plans focus on providing a marketplace premium with cost-sharing subsidies.  Also, filling the holes left by the ACA plans currently on the marketplace.

These plans would be through the ACA;  plans would be available to people and businesses. ACA’s essential health benefits would have coverage.

Medicare doctors must join in the public plan. Other doctors can join to meet the needs of children and those with special needs.

Due to rising prescription drug costs, each of these bills proposes allowing the Secretary to negotiate lower drug prices for the Federal Public plan.

Not all of the options are Medicare Buy-In options; some prefer Medicare for All or Medicare for Most.

Merkley Bill

Jeff Merkley’s bill directs the Secretary to negotiate payment rates for Medicare for Everyone; or, Part E.

Allows large employers to offer the Federal Public plan to employees. Also, the Federal Plan could operate as a Third-Party Administrator for self-insured plans.

It reduces the cost-share for most participants by tying them to Gold level plans based on income and subsidies. Additionally, it includes coverage for Part A, B, and D as well as reproductive services including abortion.

Also, adds an out of pocket limit to cost-sharing on the Federal Public plan and the current program. The ACA rating rules would extend to the large group market.

To address limitations, federal funding would be spent on navigator programs. Then, employers not offering coverage must direct employees to the navigators.

The Secretary negotiates lower drug prices for the Federal Public plan and Part D enrollees.

This option contains a failsafe; if lower drug costs aren’t available by the Secretary then prices go on the lesser of the Veterans Administration or the federal supply schedule.

Bennet Bill

The Michael Bennet bill uses Medicare rates for the new Medicare-X plan. This would ensure people don’t pay over 13% of income on healthcare premiums; although, for millions, it would be much less.

For example, a 4 person family making $101,000 would have a max 9% income on premiums. Then, there would be an increase in the tax credit for those earning less than 400% of federal poverty.

Also, the bill eliminates the arbitrary subsidy cliff, while providing premium tax credits for those that don’t qualify for assistance due to being above the 400% poverty line.

Phase in the Federal Public program in areas with minimal competition. Federal Public plans will be available at all ACA metal levels and an out of pocket limit would begin.

$30 billion over a 3-year period will go to the national reinsurance program to ensure marketplace stability. Finally, direct reforms will coordinate healthcare with employment, education, transportation, food, and housing; all of these affect health and can cause delays in accessing medical care.

Medicaid doctors must join. The Secretary would negotiate lower drug prices for the Federal Public plan and Part D enrollees.

Schakowsky Bill

Congresswoman Jan Schakowsky made a reintroduction of the Medicare for America Act in May 2019; this bill ensures affordable, universal, healthcare.

Medicare for America sounds like a true dream; coverage on drugs, dental, vision, and long term support for seniors. Health coverage is a human right, not a privilege.

Medicare for America cost structure includes no deductibles. Also, Individuals have a $3,500 maximum out of pocket and households have a $5,000 Maximum out of pocket (MOOP).

There would be a cap on premiums, at 8% of monthly income. However, those making less than 200% of the Federal Poverty Level won’t pay a premium.

Those with an income between 200% and 600% of the Federal Poverty Level would qualify for a subsidy to lower the premium and establish a MOOP sliding scale.

Two Medicare Buy-in for Older Adults Proposals

If you’re one of the millions that are 50 or older without health coverage, we hear your voice.

The Medicare buy-in for older adults would give eligible people the option to buy. Although, there is no out of pocket limit.

Beneficiaries would want additional coverage to fill the gaps. This could be in the form of a subsidy through the marketplace, a supplement, or an advantage plan.

Medigap plans must be available on a Guaranteed Issue basis for those electing the buy-in option. Also, the enrollee would pay the full cost of the benefit plan plus administrative expenses.

The marketplace is where beneficiaries can apply for financial assistance. However, the buy-in option wouldn’t compete with marketplace plans.

The Secretary would determine subsidy calculations. Medicare would continue to prohibit balance billing.

Also, the current Medicare trust fund would remain separate from the new buy-in Medicare trust fund.

Higgins Bill

The Brian Higgins Medicare buy-in plan would be available to adults 50-64. The location determines the cost of the plan.

Also, part of this plan is to commission a reinsurance program to cover the cost of high dollar claims. As well as Empower the Secretary to negotiate lower drug prices for the buy-in and the current program.

As buy-in enrollees turn 65 and are eligible for Medicare, all features revert to the current program.

Those eligible for insurance through their employer would be able to enroll in the buy-in. As well as employers being able to pay those Medicare premiums on behalf of the employee.

Commits to appropriate $500 million to raise awareness about new subsidies, consumer assistance programs and help people enroll.

Senator Stabenow Introduces Medicare at 50 Act

Debbie Stabenow’s Medicare at 50 act allows enrollment through Medicare to be available for adults 50-64. Then, buy-in costs would be based on a national premium.

This would give anyone over the age of 50 the option to buy into Medicare; lowering costs, strengthening Medicare, and improving the quality of care for millions. By covering this age group, the ACA marketplace could grow.

Tom Malinowski Expanding Health Care Options for Early First Responder Retirees

The Tom Malinowski legislation would give first responders age 50 and older to buy into Medicare. First responders usually retire early than the average worker.

Police officers, EMTs, and firefighters all would have access to Medicare buy-in at 50 years old.

Coverage under this bill would be identical to the current Medicare program.

State Public Plan Options

The State Public plan options suggest using the Medicaid program as the starting point. Although, states would have the option of creating plans that go alongside the private plans through the marketplace.

People of all income levels could buy into Medicaid, provided they have no other coverage.

Each state will determine the premium amounts based on age, geography, family size and tobacco use. Further, the state will decide deductibles and cost-sharing.

States would get federal matching payments. As a result, the bill doesn’t require premiums and cost-share to cover the full cost of the buy-in.

Instead, the states have the flexibility to market the plans with premium rates lower than those set by commercial plans. Consequently, there is an expectation the federal government pays the difference.

As with the current Medicaid program, the state would have to finance the state share of the cost.

Schatz Bill

Senator Schatz proposes a State Public Option Act which would give states the option to offer Medicaid buy-in. Essentially, this gives people a high-quality, low-cost option.

There are already at least 14 states exploring these public options with legislators.

Medicaid Buy-in Proposal

The Medicaid buy-in would be available as the Silver level plan and enrollees would get an alternative benefits package or the ACA essential health benefits.

Also, this program relies on Medicaid doctors and managed care organizations to provide services.

Key Policy Considerations

There is a way to have affordable care for everyone; however, the path to affordable care for all isn’t easy.

Each of the bills provides health care to the public, at a cost. Some plans extend coverage to everyone, while others are more selective.

Will Medicare for all increase my current Medicare cost?

Medicare for all proposes enhancing the current program to include dental and vision coverage. Although, we can expect the premium trust funds to remain separate for those over 65 and those under 65.

Also, we expect the expenses will decrease and federal spending for health care will increase. The Medicare controlled fee schedule will help maintain a fair allowance to doctors while keeping the costs in check.

Overall, the cost of an individual will lower. Premiums will stabilize because more people are in the risk pool. Benefits become premium quality thanks to the buying power of a larger group.

Who will pay for this coverage?

The switch to Medicare for all transfers costs to the federal government. Many believe the top 5% of earners will pay most of the cost. There has been no further information on financing options.

The resulting impact of any one proposal will bring its own challenges. However, there is no definitive answer on which is the best solution for our national healthcare crisis.

Medicare for All Poll

We would love to hear your feedback on the above proposals.

Would you pay a higher tax for Medicare for All if you knew your insurance cost was going down? Or, do you want Medicare for America that caps the premiums?

Is Medicare buy-in your preference?

Leave a comment below letting us know what proposals you do and don’t agree with!


  1. No this is socialism at it’s best. I am middle class and we take the hit. More beauracrats with their hands in our pockets. That’s what democrats do.

  2. Thank you for the presentation of the various ideas/plans. I plan to re-read and try to digest just what merits each plan includes. I think there is a problem with identifying the plans by the name of their “sponsor”, as this introduces political bias. Any final plan should be a hybrid which includes the good points of perhaps several of the plans mentioned above as well as new ideas and should not be merely a proposal meant to garner votes for one candidate or party vs another. My hybrid would include: an early introduction of mandatory health savings accounts at early working age; an honest dialogue regarding the importance of and ways to encourage healthier life-styles (politically inconvenient though that might be; adoption of the concept of Blue Zones in our cities is an example of a blueprint for healthier communities); keeping the government and lawyers out of the doctor-patient encounter; further tort reform; providing universal low-cost catastrophic coverage; revision, from within, of a system that makes fraud, waste and abuse so prevalent; and setting up a system with teeth that monitors accountability regarding quality, cost, continuity of care, utilization, and appropriateness of care to be overseen by state medical societies/boards, not by insurance companies, the government or the courts. If some of these items can be achieved, then cost of care will go down and insurance premiums and government expenditures should as well. The problem is not simple, it qualifies more as a huge dilemma, and only honest across the political aisle efforts as well as public and private discourse are going to move us in a positive direction. Anyone who thinks one plan will solve the problem is ignorant or in denial of the enormity and complexity of our health care dilemma.

  3. Medicare for All is “if you can afford it.” Premiums are raised again on seniors for 2020. After sales tax, for sure property tax increase 2020, home insurance increased, groceries all have increased. Will have to sell my home soon. I can’t afford it. Because medical Medicare and supplement are taking it away. Then no dental or vision. Choose the right plan? Impossible. There’s not one affordable.

  4. Medicare for all, really? Let’s see who wants longer waits for special medical needs like Pulmonologist or Cardiologist or Neurologists? Who really knows the cost and and believes some rich guy is going to pay for it? If you nuts want Medicare for all just look at medical standards in the UK or Canada for instance. Check out the issues at our own Veterans Administration. Last of all what happens to all the jobs lost at regular insurance companies. Medicare for all, not me!

  5. Remember a time when Blue Cross was our health care plan? Everyone paid in, premiums were lower, you could go to any Doctor in any state and there was no problem. Perhaps Medicare for all can bring that back. Everybody in, everybody pays and costs go down. Right now I am obligated to buy coverage by the area of the state I live in. Health care is frustrating and costly.

  6. I would love to see a program that lowers the annual cost of my wife’s and my insurance, which is over $10,000 for my Medicare, Medicare Supplement, Part D retiree thru my employer, her employer health insurance, our dental, and long-term care. Fortunately our retiree insurance thru our employer will cover $5,000 toward hearing aids starting in 2020. However, I also know that as middle-class, we will probably end up paying for those who can’t afford it, so will there be any cost savings? The buy-in for age 50-64 seems like a good option, especially for people who have health issues and need to retire, but can’t because they need insurance. Or in the case of a friend of ours, the spouse is several years older and when he retired, she lost her healthcare coverage, and had to purchase insurance until she was eligible for Medicare..

  7. Capitalism develops the best products and services because of profits. The various Medicare expansion plans all fail to provide the profitable funding for doctors, research scientists, hospitals and pharmaceutical companies that is necessary for the incredible advances that have been made. But just because a medical procedure or drug has been developed does NOT mean that it becomes available for every person who happens to live in this country. That is NOT a right, never will be a right, and cannot be a right if we want medical advances to continue. It is not possible to keep the best medical technology in the world and sell it at Medicare benefit pricing. We have no rights to drive Cadillacs, eat in gourmet restaurants, take 8 week vacations, send our children to Ivy League schools, and live a life of leisure with money left over. Of course wealthy people get more than poor people. Welcome to the planet earth.

  8. What no one is talking about is the financial impact on physicians who would take reduced fees and not cover the costs of their practice and impact fewer new entrants into the medical profession, the impact of reduced revenue on hospitals who struggle today to stay profitable and have capital to invest in new Equipment such as MRIs, the impact of having the government run our healthcare as they now run the Department of Veteran Affairs (VA) which is inconsistent, ineffective and expensive The VA only covers 8 million Veterans for healthcare- that’s right only 8 million the impact of all healthcare professionals being unionized including physicians as they are in the VA, the impact of the demise of the Insurance and the millions of people employed by the insurance industry and who currently get care through their employers. I could go on but a transition to a government run system is extraordinarily high risk. People use Canada and UK as positive examples of “everyone is covered”. These statements are spoken out of lack of knowledge of these countries healthcare system and the issues they face. Months of waiting to get critical care ( such as cancer treatment) or diagnostic tests to determine the critical care possibility are common as they are in our VA’s. In Canada if you want care faster you open up your wallet. It is a 2 tier system.

  9. Is there really an alternative to a single payer system that has worked in the last twenty years, the answer is an unequivocal “no.” Medicare-For-All is still less expensive than the current inefficient way we deliver healthcare in this country, a fact that many want to just ignore. The time has come to do something definitive about millions of people who are uninsured and under insured. If there was a better answer than Medicare-For-All we would have found it by now. Medicare is a program that works for millions of Americans and can work for millions more.

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