A bill before Congress would allow the Secretary of Health and Human Services to automatically enroll newly eligible citizens into a Medicare Advantage (MA) plan with a mandatory three-year enrollment.
H.R. 3467, sponsored by Rep. David Schweikert (R-AZ), would amend the Medicare Advantage Reform Act to mandate automatic MA enrollment for plan years on or after January 1, 2028, for individuals who do not elect otherwise. Americans are automatically enrolled in Medicare Part A (hospitalization), which is premium-free when they turn 65. Enrollees must then enroll in MA or traditional fee-for-service (FFS) Medicare, both of which are premium-based.
The automatic enrollment provision in H.R. 3467 would require assignment to the lowest-premium MA plan available or, if there are multiple plans at the same cost, “in a manner determined appropriate by the Secretary.”
Enrollees would be allowed to decline the assignment.
Schweikert has provided little commentary on why he is sponsoring the bill and has not sent out a press statement about it.
Congress’s Medicare Payment Advisory Commission (MedPAC) stated in its 2024 report MA would cost taxpayers $83 billion for that year, 22 percent more than FFS Medicare.
Strong Opposition
While the most vocal opposition to the bill has centered on a separate provision that would require MA to include hospice care, the three-year auto-enroll provision and unspecified opt-out rules have spurred concern from patient advocates and health care analysts.
“It’s a terrible idea to keep people stuck in a plan that may not work,” said Robert Klein, an independent Medicare and long-term care consultant with The Ardmore Group Klein and policy advisor to The Heartland Institute, which co-publishes Health Care News. “Under current rules, the annual enrollment gives seniors options to change to a different Medicare Advantage plan or to go to original Medicare and a supplement, although there are some tricky rules depending upon your particular state of residence.”
Trapped Enrollees
Americans should be suspicious of auto-enrollment in general, says Twila Brase, president and cofounder of the Citizens’ Council for Health Freedom, which published a Medicare How-To Guidelast October.
“Auto-enrollment by the government is socialism; it’s anti-American,” said Brase. “It’s the antithesis of freedom. It is wrong to force senior citizens into an MA plan, and it is wrong to force them to pay for that plan for three years unless they figure out how to opt out in what time frame the Secretary specifies.
“MA limits access to doctors, hospitals, and treatment,” said Brase. “Original Medicare does not. Locking senior citizens into plans that may jeopardize their health or threaten their lives should not be allowed.”
The three-year auto-enrollment as a step backward for seniors, says Robert Klein, a tax consultant with The Ardmore Group, and a policy advisor to The Heartland Center, which co-publishes Health Care News.
“It’s a terrible idea to keep people stuck in a plan that may not work,” said Klein. “Under current rules, the annual enrollment gives seniors options to change to a different Medicare Advantage plan or to go to original Medicare and a supplement, although there are some tricky rules depending upon your particular state of residence.”
Adjusting for Risk
In Medicare Advantage, private insurance companies compete to take on the sickest enrollees.
The free-market concept, however, has faced an obstacle. In 2023, the Biden administration eliminated 2,000 diagnostic codes for MA, which limited providers’ ability to adjust for risk.
Hospitals are adding to patients’ concerns by refusing to admit MA enrollees, a practice that is not very surprising, said John C. Goodman, the president of the Goodman Center for Public Policy Research and co-publisher of Health Care News, told the publication on May 27, 2025.
“MA plans have a financial incentive to scrupulously monitor emergency-room decisions and challenge them if they appear unjustified,” said Goodman. “No wonder hospitals like traditional Medicare as a payer rather than Medicare Advantage. But remember, when MA plans eliminate unnecessary spending, they are ultimately saving taxpayers money.”
Medicare Collapse
Schweikert’s bill may provide a lifeline for legislators who want to stave off Medicaid insolvency by having insurers ration care, says Brase.
“The Medicare Trustees estimate Medicare will be insolvent in 2033, eight short years from now,” said Brase. “Perhaps MA plans have promised Congress that they can extend the life of Medicare by limiting patients to only the care the plans deem necessary. This will lead to the corporate rationing of care.”
A far better solution is to stop forcing people into Medicare and allow them to get the insurance they really need, says Brase.
“The only compassionate way to extend the life of Medicare is to provide seniors with a way to opt out of Medicare without losing their Social Security benefits,” said Brase. “Congress must also provide them with access to the affordable medical indemnity insurance policies that Obamacare prohibits, the policies that pay solely for catastrophic and insurable events.
“Seniors need an escape plan, not a rescue plan,” said Brase. “Congress must open the door and let Americans choose to leave Medicare.”
Kevin Stone ([email protected]) writes from Arlington, Texas,
