2025: A Year of Old Threats and New Opportunities

As 2024 winds down, our sights turn to 2025, which will see a new Congress and administration. Amid these shifts and always, Medicare Rights will focus on protecting and expanding access to high-quality, affordable health care for older adults and people with disabilities. Below, we outline several key threats and opportunities in the new year.

The Threats

Caps and Cuts

Medicare, Medicaid, and the Affordable Care Act (ACA) are deeply interconnected. Program cuts, limitations of eligibility, or barriers to care have widespread ripple effects. For example, cutting or capping Medicaid harms enrollees directly through loss of coverage and also affects the health care workforce, families, and taxpayer pocketbooks. In addition, cuts to Medicaid or ACA coverage at the federal level can overburden states that pick up the slack and lead to people going without care entirely, at the expense of their health and financial security.

Program cuts, limitations of eligibility, or barriers to care have widespread ripple effects.

Some cuts come disguised as program reforms. Work requirements or increasing the frequency of redeterminations, for example, do not directly impair Medicaid funding, but do kick people out of the program, most often people who are still eligible but who are struggling to meet or certify new, bureaucratic requirements.

We will be fighting against these cuts and caps. In Medicare, this includes ideas that limit eligibility and burden beneficiaries like raising the eligibility age, increasing means testing, allowing private contracting, and moving to premium support or voucher programs.

Medicare Advantage (MA) Overpayment

As enrollment in MA surges, researchers and advocates know that MA overpayment is severely harming Medicare’s financial situation. But that hasn’t stopped some from trying to increase enrollment even more and boost profits in a market increasingly dominated by a handful of national plans. Medicare Rights will continue to educate and inform policymakers, partners, and taxpayers about the risks of MA overpayment, as well as advocate for more accurate payments and a more sustainable system.

Legislative Reversals

The Inflation Reduction Act (IRA) made many important changes to Medicare coverage including creating an out-of-pocket cap on Part D spending and eliminating cost-sharing for recommended vaccines. The most politically eye-catching, and the one likely to be at most risk, is the new drug price negotiation program that will save people with Medicare billions of dollars in the coming years. We will work to protect and build upon these gains to further improve prescription drug affordability.

The Opportunities

Coverage Expansions

Over the last several years, members of Congress have become more aware of gaps in Medicare’s coverage, especially for vision, hearing, and dental care, as well as mental health and substance use disorder care. We will continue to push for coverage expansions, an out-of-pocket cap in Original Medicare, and parity between behavioral health and physical health coverage in Medicare.

MA Abuses

Many on Capitol Hill have known about or are newly aware of MA plan exploits like network inadequacy and ghost networks, marketing, denials and prior authorization abuses, and upcoding. As lawmakers search for areas of bipartisan agreement, they may turn to these obvious issues. We will bring our beneficiary-informed knowledge of these problems and their impacts to policymakers in Congress and the administration.

Site Neutrality and Transparency

Ensuring that people with Medicare and the program itself are not overpaying for care is another area of potential bipartisan action. In 2024, Congress nearly passed a reform that would regularize some Medicare payments, but the effort fell just short. Medicare Rights will continue to support these efforts alongside our valued partners.