Major Changes in Medicare Eligibility Proposed; Biggest in 50 Years

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Newly introduced legislation would lower Medicare initial enrollment age to 60, possibly with expanded benefit coverage. Ensurem’s Dave Rich explains what’s being considered.

The U.S. Congress is considering the most sweeping changes to Medicare in its 56-year history.

On the face of it [lowering the age to 60] is a great idea. However, many unanswered questions remain. Medicare is already underfunded, and it is not yet clear where the money would come from to cover these additional enrollees

The Improving Medicare Coverage Act of 2021, introduced in the House of Representatives in early September, would, if enacted, lower the age of eligibility for Medicare to 60. According to the cosponsors of the bill, this would expand Medicare coverage to some 23 million people, nearly 25% of whom have no health insurance coverage.(1) “On the face of it,” says Dave Rich, CEO of Ensurem, a Florida-based insurance technology and product distribution firm, “this is a great idea. However, many unanswered questions remain. Medicare is already underfunded, and it is not yet clear where the money would come from to cover these additional enrollees.”

Medicare, notes Rich, has a long and complicated history. The first president to call for a national health insurance program for Americans was Theodore Roosevelt, who made it a part of his platform in 1912. Harry Truman called for such a plan in 1945, and Medicare became a reality in 1965, when Lyndon Johnson signed it into law. As of January 2021, there were 63.1 million people enrolled in Medicare.(2)

Along with lowering the eligibility age, the Biden administration’s current proposed budget for Medicare would expand its coverage to include dental care, vision, and hearing.(3) Sponsors of the legislation note that:

  • Nearly two-thirds of Medicare beneficiaries have no dental coverage, and half of all beneficiaries report that they have not seen a dentist in the past year;
  • About one-third of all those between the ages of 65 and 74 have some degree of hearing loss, as do nearly half of those older than 75. On average, hearing aids cost between $1,000 and $5,000.(4)

Desirable as they might be, these coverage expansions, says Rich, are unlikely to take place. In order to avoid the need for a supermajority vote in the Senate, the proposed budget plan will go through a complex process known as budget reconciliation, in the course of which the administration’s party will almost certainly have to remove some of its core policy elements. The bill will also, after debate closes but before final passage, face a theoretically unlimited number of proposed Senate amendments in the course of what is known as a “vote-a-rama.”(5)

Regardless of the outcome of these negotiations, says Rich, it seems likely that there will be changes in Medicare coverage for 2022, as there is virtually every year. To one degree or another, these changes will be reflected in the available array of Medicare Advantage plans, now used by over 40% of all Medicare beneficiaries.

Making the best choice among these possibilities, Rich notes, is already quite complex, and—given the growing number of plans offered each year—likely to become more so. “Whether or not proposed legislative and budgetary changes to Medicare are enacted,” says Rich, “it will be more necessary than ever for beneficiaries to seek advice before enrolling in or changing plans.”

About Ensurem:
Ensurem, headquartered in Largo, FL, is a leading technology and product distribution company serving carriers and consumers within the massive U.S. senior market. The company offers Medicare Advantage, Medicare Supplement, vision, dental, hospital indemnity and final expense insurance. It also provides end-to-end solutions for carriers, including product development, digital marketing and consumer-centric insurance technologies. For more information, please visit

1.    Grayer, Annie. “Democrats Push to Lower Medicare Eligibility Age to 60.” CNN, Cable News Network, 3 Sept. 2021,
2.    Anderson, Steve, et al. “A Brief History of Medicare in America.”, 24 Mar. 2021,
3.    O'Brien, Sarah. “Medicare Expansion and a LOWER Eligibility Age Are Included in Democrats' $3.5 Trillion Budget Plan.” CNBC, CNBC, 9 Aug. 2021,
4.    Gleckman, Howard. “Adding Dental, Vision, and Hearing to Traditional Medicare Would Be Expensive, but Important.” Forbes, 27 July 2021,
5.    McDaniel, Eric, and Snell, Kelsey. “A $3.5 Trillion Question: What Is Budget Reconciliation? Here's an Explainer.” NPR, 14 Sept. 2021,

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Karla Jo Helms
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