CMS Mulls Auto-Enrolling Seniors Into Medicare Advantage

When your patients turn 65, will they automatically be enrolled in a Medicare Advantage plan or accountable care organization (ACO)? That idea is now on the Trump administration’s radar.

CMS is currently mulling a plan that would automatically enroll beneficiaries into either Medicare Advantage plans — in which private insurers contract with CMS to serve Medicare beneficiaries — or ACOs, such as those that participate in the Medicare Shared Savings Program, according to a report in STAT.

Currently, people who don’t make a choice are enrolled in traditional Medicare, which offers seniors the opportunity to see any doctor that takes Medicare; however, traditional Medicare is not the option favored by the Trump administration. Would auto-enrollment in either an ACO — which is financially incentivized to provide more efficient care at a lower cost — or Medicare Advantage be better than fee-for-service (FFS) Medicare, “where there’s not this long-term, secular relationship between the beneficiary, the patient, and their provider? Yes,” Chris Klomp, director of CMS’s Center for Medicare, said in the STAT interview.

Republicans argue that Medicare Advantage, with its smaller physician networks and stricter prior authorization rules, can save the Medicare program money. But a report by the Medicare Payment Advisory Commission (MedPAC) in March 2026 found that Medicare paid $76 million more for Medicare Advantage patients in 2025 than it would have if those same patients had been enrolled in traditional FFS Medicare.

“The higher payments that we estimate relative to FFS vary significantly across MA [Medicare Advantage] parent organizations and are not an estimate of plan profits and administrative expenses,” the report noted. “These increased payments to MA plans contribute to funding for the supplemental benefits plans provide. However, the relatively higher payments to MA plans are financed by the taxpayers and beneficiaries who fund the Medicare program. Higher MA spending increases Part B premiums for all beneficiaries, including those in FFS Medicare who do not enjoy subsidized supplemental benefits.”

The idea of Medicare Advantage auto-enrollment is not a new one. Page 465 of the Heritage Foundation’s Project 2025 report — released in 2023 and considered by many to be a blueprint for the Trump administration — lists several suggestions for strengthening the Medicare program, with the first one being “Make Medicare Advantage the default enrollment option.”

Health policy analysts had mixed reactions to the idea, which Klomp said is something his team is just thinking about at this point. “It’s a good thing,” said Tom Campanella, a healthcare consultant in Cleveland, Ohio. However, “if [it] means we’re denying needed and appropriate services, that’s a bad thing. So there needs to be some form of guardrails or user-friendly transparency,” especially in terms of posting patient outcomes, he said in a phone interview.

Campanella disputed the FFS comparison in the MedPAC report. “I think focal point should not be, in effect, to clone traditional Medicare as a benchmark,” he said. “Traditional Medicare historically has been entrenched with high healthcare costs, many related to the fee-for-service policy of ‘The more you do, the more you make.’ And a good chunk of people have Medigap coverage, and they have all their healthcare services covered — or a good chunk of them — which results in increased utilization.”

But Tricia Neuman, executive director for the Program on Medicare Policy at KFF, in Washington, had other concerns. “One question, for example, is how would the government choose a plan on behalf of a beneficiary?” she said in an email. “Some people, particularly people with serious chronic conditions, value their relationship with their doctors and place a high priority on continuity of care when they transition on to Medicare. Would the government assign a new Medicare beneficiary into a Medicare Advantage plan that allows them to continue treatment from their preferred doctors and specialists, or is there a risk they would be auto-enrolled into a plan with a provider network that would mean having to change doctors?”

“Would the assignment process give preference to insurers with certain characteristics, such as zero-premium products, plan type (HMO vs PPO), or plans with relatively high star ratings?” she continued. “Would the choice be based on random assignment?” And if Medicare Advantage auto-enrollment does result in higher costs for the Medicare program, “[that] could make the model less attractive to insurers,” Neuman added.

At least one member of Congress also is interested in the auto-enrollment idea. Rep. David Schweikert (R-Ariz.) introduced a bill in May 2025 that would automatically enroll anyone eligible for Medicare parts A and B “into the MA plan with the lowest premium available to such individual.” Although the bill says that each auto-enrolled person would be given “an opportunity to decline such enrollment,” it also states that anyone who is auto-enrolled into a Medicare Advantage plan cannot, for the following 3 years, “elect to receive benefits under this title through traditional fee-for-service Medicare under part A or B,” suggesting a 3-year lock-in period. Schweikert’s bill currently has no co-sponsors.