President-elect Donald Trump has nominated heart surgeon Dr. Mehmet Oz to run Medicare and Medicaid, the massive government programs that provide health care to 150 million Americans. What could this mean if you are on Medicare or will enroll in the coming years?
No one knows for sure, though, and Oz would need Senate confirmation to become 19.Th Based on what we’ve heard from him, the administrator of the Centers for Medicare and Medicaid Services (CMS), it’s possible to read the tea leaves, Trump, and Robert F. Kennedy Jr.—Oz’s boss if he passes the Senate. It is confirmed that the Department of Health and Human Services.
Trump and Oz have been friends for 20 years, and Oz served on Trump’s Council on Sports, Fitness and Nutrition during his first term.
In a statement nominating the host of America’s most popular TV doctor talk show to work with Kennedy and “take on the disease industrial complex,” Trump wrote: “To make America healthy again, Dr. There could be no more qualified and capable physician than Oz.”
But, STAT News reporter Leo Fechter told PBS, Kennedy and Oz are “about as out of the mainstream as you can think for the choices to run the Department of Health and the Centers for Medicare and Medicaid Services.”
Speaking at the Gerontological Society of America (GSA) conference in Seattle last week before Trump chose Oz, Andrew McPherson, managing partner of the nonpartisan health care consulting firm Healthsperien, said: “The Trump administration’s Also, federal health insurance programs will be under scrutiny.”
During his 2024 presidential campaign, Trump said he would “not cut a dime from Medicare.” Language from the 2024 GOP platform said Republicans would “protect Medicare and ensure seniors get the care they need without being burdened with excessive costs.”
But that doesn’t mean Medicare won’t change during Trump’s second term.
As you might expect, some Republicans in Congress have wholeheartedly supported Oz and some Democrats have said he shouldn’t get the CMS post.
Here’s a list of what you might expect from Dr. Oz (who lost his bid to become a Republican senator from Pennsylvania in 2022) if he were to run Medicare, Medicaid and the Affordable Care Act at the 6,000-person CMS. are, as well as what is impossible to know:
Promoting Medicare Advantage plans
Medicare beneficiaries can choose between traditional Medicare (Parts A and B, also known as Original Medicare) and private insurers’ Medicare Advantage plans (Part C). Currently, 54% are in Medicare Advantage plans.
Medical experts expect Oz and the president to push these plans ahead of traditional Medicare.
Oz has a Medicare Advantage validation history. When he ran for Senate and was asked by AARP how he would strengthen Medicare, Oz said: “We can expand Medicare Advantage plans. These plans are popular with seniors, provide consistent quality care. and provide the necessary incentives to keep costs down.
The Dr. In an episode of The Oz Show, he and a Medicare Advantage agent discussed buying a policy. “Millions are doing it; so can you,” Oz said.
Trump and Oz may seek to make Medicare Advantage plans the default choice for Medicare beneficiaries, as suggested in the Project 2025 report.
“I think there will be a conversation around that,” McPherson said.
However, it’s unclear whether Oz will block the 2026 scheduled rule that requires Medicare Advantage members to provide prior authorization results early.
Bob Blancato, a senior attorney, said at the GSA conference: “We need to keep an eye on the partial privatization of Medicare Advantage, Medicare.”
In 2020, Oz co-authored an article calling for a system-wide Medicare Advantage that he dubbed “Medical Advantage.”
It would make sense. every Americans other than Medicaid (the state-federal health program for low-income Americans) will sign up to buy government-administered health insurance sold by insurance companies — not just people age 65 and older.
This new Medicare Advantage program would be financed by a 20% payroll tax, half paid by employers and half by employees. Policies will have a $1,000 annual deductible. In 2025, the $257 Part B deductible and $1,676 Part A deductible in traditional Medicare are for inpatient hospital services.
Oz said Medical Advantage coverage would be much better than what is currently available to most people.
Detection of medical waste and fraud
When Trump announced his CMS nomination, he said Oz would also “reduce waste and fraud within our nation’s most expensive government agency, which accounts for one-third of the nation’s health care costs.” is, and is a quarter of our entire national budget.”
It seems like a lot of waste, and possibly fraud, to try to get Oz out of Medicare and Medicaid.
In April 2024, the US Government Accountability Office (GAO) said the two programs were “prone to payment errors – more than $100 billion in 2023.” The GAO said these “improper payments” were either incorrect amounts or should not have been made at all.
Medicare spends $1.0 trillion to provide health care services to nearly 66 million Americans in 2023; Medicaid contributed $849 billion in federal and state spending for nearly 90 million people.
If Oz and Trump can dramatically cut waste and fraud, it could help keep Medicare afloat.
The program’s hospital trust fund is expected to have serious solvency problems in 2036, which worries Americans. In a recent NerdWallet survey, 74% of respondents with Medicare said they were worried about their benefits being cut in their lifetime.
The 2024 Republican platform said the part would “strengthen Medicare for generations to come,” but didn’t say how.
Eliminated Medicare’s $2,000 cap on drug costs
The Biden administration’s Inflation Reduction Act lowered the maximum annual cost for Medicare beneficiaries enrolled in their plans, and experts believe Oz will not seek to raise that limit.
Although Project 2025 calls for repealing the deflationary law, “no one is going to mess with the $2,000 cap,” Blancato said at the GSA conference before Oz was nominated.
Curbing Prescription Drug Prices
Oz and Trump have said they want to make prescription drugs more affordable. While running for Senate, Oz told AARP: “Burdensome regulations in Washington make prescription drug prices worse. We’re introducing new ways to reduce time and money wasted on ineffective products. It will also speed up clinical studies on developed drugs, so life-improving drugs can reach the elderly sooner and at lower costs.”
But it’s unclear whether Oz and Trump will continue or expand the Inflationary Reduction Act’s program that allows Medicare to negotiate prices with drug companies.
“Trump has talked about negotiating drug prices. He might change the number of drugs that can be negotiated, but he won’t repeal it,” Blancato said. said
Ending nursing home staffing rules
As part of his CMS job, Oz will oversee the nation’s nursing homes. Some believe he could overturn new federal nursing home staffing standards initiated by the Biden administration, which would allow nursing home operators to choose their own staff.
Cutting Medicaid
Medicaid, among other things, provides long-term care coverage for people enrolled in the program. Experts believe Oz and Trump will look for ways to lower Medicaid costs.
This can be done by changing the rules about who qualifies for benefits (such as establishing a work requirement to receive them) or by shifting Medicaid funding to local block grants.
Tinkering with the Affordable Care Act
While Oz and Trump are not expected to dismantle the Affordable Care Act (ACA) and Oz has called it “half-baked,” experts expect changes to the program.
“The ACA will not be repealed or replaced, but the Trump administration will eliminate aspects they don’t like, such as premium subsidies that will expire at the end of 2025,” McPherson said.
Blancato said: “This subsidy is used by 20 million people. If they go after the subsidy, it could mean a 79 percent premium increase.
Two unknowns: telehealth and the hospital at home
There are two areas of Medicare coverage where it’s impossible to know what Oz might do because Congress and the Biden administration need to make decisions about them by the end of the year.
The first is whether to continue to allow nationwide Medicare coverage for telehealth visits with doctors. That coverage is set to expire on December 31 unless Congress and Biden extend it.
The second is whether Medicare will continue to cover hospitalization at home. That coverage will also end on December 31, unless Congress and the president push back that date.
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