The Trump administration implemented several significant changes to Medicare between 2017 and 2021 that reshaped aspects of how the program functions and what it covers, according to a Medicare lawyer at the firm Nicholson and Eastin.
One of the most notable changes was the expansion of telehealth coverage under Medicare, initially driven by the COVID-19 pandemic. While telehealth services were previously limited primarily to rural areas, the administration temporarily broadened access to allow beneficiaries nationwide to receive virtual care.
This included allowing patients to receive telehealth services from their homes rather than requiring them to go to designated medical facilities.
These are privately-run alternatives to traditional Medicare. These changes included giving Medicare Advantage plans more flexibility to offer supplemental benefits not covered by traditional Medicare, such as adult daycare services, home modifications, and meal delivery. The goal was to address social determinants of health and provide more comprehensive care options for seniors with chronic conditions.
Prescription drug pricing was another area of focus. The administration implemented new policies aimed at lowering drug costs, including a rule allowing states to import certain prescription drugs from Canada. They also finalized a “Most Favored Nation” model for Medicare Part B drugs, designed to link payments for certain medications to lower prices paid in other developed countries, though this rule faced legal challenges and implementation delays.
This includes how healthcare providers are reimbursed. They scaled back some mandatory bundled payment programs while introducing new voluntary payment models through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. These models were designed to shift Medicare away from traditional fee-for-service payments toward value-based care arrangements that reward providers for improved patient outcomes rather than the volume of services provided.
Another significant change was the expansion of Medicare coverage for kidney care. The administration launched the “Advancing American Kidney Health” initiative, which included new payment models for kidney disease treatment and expanded coverage for home dialysis options. This represented a substantial shift in how Medicare approaches kidney care, which accounts for a significant portion of Medicare spending.
They mandated that hospitals post their standard charges for items and services online in a consumer-friendly format. While not exclusively a Medicare policy, this change affected Medicare beneficiaries by providing them with more information about healthcare costs.
In terms of Medicare enrollment, the administration implemented changes to the Medicare Plan Finder tool on Medicare.gov, aiming to make it easier for beneficiaries to compare coverage options. However, some advocates argued that the redesigned tool initially had issues that made it more difficult for seniors to make informed choices about their coverage.
They expanded coverage for certain screening services and adding new preventive benefits. This included coverage for additional cardiovascular disease preventive services and expanding coverage for diabetes prevention programs.
Medicare Supplement Insurance (Medigap) policies also saw changes during this period. The administration implemented provisions of the Medicare Access and CHIP Reauthorization Act that affected Medigap plans, including eliminating certain plan types and changing how some plans cover the Part B deductible for newly eligible beneficiaries.
The administration increased efforts to combat waste, fraud, and abuse in the program. This included expanding the use of advanced analytics to identify potentially fraudulent claims and strengthening program integrity measures.
The administration also modified how Medicare Advantage plans are paid, updating the risk adjustment model used to calculate payments to these plans. This change was designed to more accurately reflect the cost of caring for beneficiaries with multiple chronic conditions.
Quality measurement and reporting requirements for Medicare providers also evolved under the Trump administration. The administration refined various quality programs, including the Hospital Value-Based Purchasing Program and the Merit-based Incentive Payment System (MIPS) for physicians.
The administration implemented several initiatives aimed at cutting red tape and simplifying Medicare documentation requirements, particularly for physicians and other healthcare professionals participating in the program.
The administration also made changes to Medicare’s coverage of medical devices, implementing new policies to accelerate coverage of innovative medical technologies. This included the Medicare Coverage of Innovative Technology (MCIT) rule, which was designed to provide national Medicare coverage for FDA-designated breakthrough devices.
The administration’s policies had varying effects on the program’s trust fund. While some measures were implemented to reduce costs and improve efficiency, the long-term financial challenges facing Medicare remained a significant concern.
It’s worth noting that some of these changes were modified or faced legal challenges during implementation, and others were still in various stages of implementation when the administration ended. Additionally, some changes were temporary measures implemented in response to the COVID-19 public health emergency, while others represented more permanent shifts in Medicare policy.
The Trump administration’s changes to Medicare reflected a broader healthcare policy agenda focused on increasing market competition, reducing regulations, and expanding private sector involvement in the program. While some changes were welcomed by healthcare providers and beneficiaries, others generated controversy and debate about their potential impact on Medicare’s future and the quality of care provided to beneficiaries.
Time will tell what changes will be made during this administration. The lasting impact of these Medicare reforms will ultimately be determined by their long-term effectiveness in improving healthcare delivery, reducing costs, and enhancing the quality of care for beneficiaries. As the healthcare landscape continues to evolve and new challenges emerge, future administrations will likely build upon or modify these changes to address the ongoing needs of Medicare beneficiaries and ensure the program’s sustainability for generations to come.
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