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U.S. President Donald Trump holds up an executive order on Medicare he signed during an event at The Villages retirement community in The Villages, Florida, October 3, 2019. Photo by Kevin Lamarque/Reuters

Column: What seniors should know about Trump’s Medicare executive order

Journalist Philip Moeller answers your questions about health, aging, and retirement. Phil is the author of the book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.


President Trump signed an executive order Thursday to expand private Medicare insurance plans. The effort has been billed as the president’s alternative to Democrats’ Medicare for All plans, which are being attacked by the White House as efforts to socialize U.S. health care.

In announcing the presidential action, the White House incorrectly claimed that congressional Democrats wanted to eliminate private health insurance proposals and let the federal government “decide who lives and who dies.”

“The Democrats’ plan for socialized medicine will not just put doctors and hospitals out of business. They’ll also deny your treatment and everything that you need,” Trump said at a speech in The Villages retirement community in Florida on Thursday.

In earlier remarks to reporters, Seema Verma, head of the Centers for Medicare and Medicaid Services, called Medicare for All “impractical” and “morally wrong.”

Democratic presidential candidates have defended Medicare for All as a way to fight back against greedy private insurance companies, and in response to Trump’s latest executive order, Democrats in Congress pointed the finger at Trump for failing to consider Democratic legislation that aims to lower health care costs for seniors.

Who the order affects

Trump’s executive order aims to help further expand Medicare Advantage plans, which are private insurance plans now used by about a third of the nation’s 61 million Medicare enrollees.

Most seniors and disabled persons on Medicare are enrolled in basic Medicare, which is managed by the federal government. Some Democrats’ proposals would expand this type of Medicare and either reduce or exclude the role of private health insurers in favor of a government-run program.

Basic Medicare consists of coverage for hospital and nursing home costs (Part A) and expenses for doctors, outpatient services, and durable medical equipment (Part B).

READ MORE: Why Medicare needs to be fixed before it works ‘for All’

The government pays only 80 percent of covered Part B expenses, leading many Medicare enrollees to also buy private Medigap insurance plans to plug this and other coverage gaps in basic Medicare. People with basic Medicare also buy separate Part D drug plans, which are also run by private insurers.

Medicare Advantage plans, by contrast, can bundle all Medicare coverage into a single package. The plans usually cost less than add-ons to basic Medicare. The plans cover people only for services provided by doctors, hospitals and other care providers in a plan’s provider network, and usually limit coverage to an enrollee’s home market. People with basic Medicare, by contrast, are covered for care anywhere in the U.S. from participating Medicare providers.

What’s changing

Through new laws and regulations, the Trump administration has already expanded the services that Medicare Advantage plans can cover but which basic Medicare is not allowed to cover. This list includes limited dental, hearing, and vision coverage, as well as gym memberships and so-called supplemental benefits that may encompass transportation to medical appointments, home-delivered meals, and non-medical health and safety aids such as bathroom grab bars.

The president’s order directs the secretary of health and human services to propose new regulations that would enable Medicare Advantage plans to offer more flexible plans and boost the use of telehealth services.

Medicare Advantage plans have become increasingly popular among seniors and also increasingly profitable for private health insurers. In a recent report, the Kaiser Family Foundation analyzed health insurer programs and found that private insurers made gross profits of more than $1,600 on each Medicare Advantage customer – nearly double their gross margins from individual health policies and employer group plans.

READ MORE: 3 problems that are spiking health care costs, according to this surgeon

The executive order also supports expansion of health savings accounts. It directs the Social Security Administration to no longer require people who receive Social Security to also enroll in Part A of Medicare. This requirement has prevented employed people with health savings accounts from continuing to contribute to those accounts when they claim Social Security benefits.

This story has been corrected to indicate there are 61 million Americans enrolled in Medicare, not 66 million as previously reported.

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