Opinion: Congress’s Medicare Auto-Enrollment Proposal Would Trap Many Seniors

As a gerontologist who has guided many older adults through Medicare’s complexities, I have seen how a single enrollment decision can shape someone's health, finances and independence for years. That is why H.R. 3467—legislation introduced by Rep. David Schweikert (R-Ariz.)—should concern anyone who cares about protecting older Americans’ autonomy and access to care.

What the bill would do

H.R. 3467 would automatically enroll new Medicare beneficiaries into the lowest-premium Medicare Advantage plan available in their ZIP code unless they actively opt out. Those auto-enrolled would be locked into that plan for three full years, with the opportunity to change coverage limited to narrowly defined hardship exceptions.

Why this matters

At first glance, auto-enrollment may sound efficient. But replacing an informed choice with an algorithmic default removes the control beneficiaries need to match coverage to their medical and financial realities. Medicare Advantage plans can offer attractive extras—dental, hearing and fitness benefits—but they often rely on narrow provider networks, require prior authorization for care, and can expose enrollees to higher out-of-pocket costs when they need care most.

Imagine being 72, newly diagnosed with cancer, and learning your assigned plan does not cover your long-time oncologist—and that you cannot switch plans for three years. That is not a benefit; it is a bureaucratic trap.

Who would be harmed

The proposal would disproportionately affect people with cognitive impairment, low digital literacy, limited internet access, or little access to trusted advisers. Many older adults already face aggressive marketing and confusing materials from insurers; a multi-year lock-in could make correcting an honest enrollment mistake nearly impossible. Family caregivers—nearly one in five Americans who provide unpaid care to an adult aged 50 or older—would face added stress managing denials, appeals and out-of-network care issues.

Other concerning structural changes

H.R. 3467 also contains structural reforms that could shift power toward insurers: it moves Medicare Advantage payments to a capitated model beginning in 2028, restricts risk-adjustment calculations to diagnoses documented through face-to-face or telehealth visits within the prior two years, and integrates hospice into Medicare Advantage—reversing the traditional hospice "carve-out." Together, these changes could alter incentives and constrain clinician and patient decision-making.

A better path

If lawmakers want to improve Medicare enrollment and outcomes, they should strengthen informed choice and transparency rather than impose defaults. Practical alternatives include:

• Expanding State Health Insurance Assistance Programs (SHIPs) to provide free one-on-one counseling before enrollment decisions;
• Requiring clear, plain-language side-by-side comparisons of Medicare Advantage and traditional Medicare benefits, networks and likely out-of-pocket costs;
• Publishing plan denial rates and out-of-network access data so consumers can see how often coverage limits affect care;
• Investing in geriatric care coordination, caregiver education, and digital-literacy support to help families navigate choices.

These reforms empower beneficiaries, respect the complexity of aging, and preserve patient and clinician control over care decisions.

H.R. 3467 remains in committee and has not advanced to a full House vote. There is still time for members of both parties to reconsider the long-term consequences. Older Americans have earned the right to make informed choices about their health care; policymakers should protect that right rather than replacing it with automatic assignment.

About the author: Michael Pessman is a gerontologist and virtual programs assistant at Mather in Evanston, Ill., and a Public Voices Fellow through the OpEd Project.