Congress’s Medicare ‘auto-enrollment’ bill is a trap  

As a gerontologist who has helped countless older adults navigate the Medicare maze, I’ve seen how one enrollment decision can shape someone’s quality of life for decades. That’s why the new legislation before Congress, H.R. 3467, should alarm anyone who cares about protecting older Americans’ health and autonomy. 

The bill, sponsored by Rep. David Schweikert (R-Ariz.) and introduced in May, would automatically enroll new Medicare beneficiaries into the lowest-premium Medicare Advantage plan available in their ZIP code unless they actively opt out. Even more troubling, it would lock them into that plan for three full years, limiting their ability to switch back to traditional Medicare or select a new plan except under narrowly defined hardship circumstances. 

At first glance, “auto-enrollment” sounds efficient, with fewer decisions to make at a confusing time. But when you dig deeper, this proposal removes freedom rather than simplifying a decision. Many would find themselves stuck in private insurance plans they never chose, possibly unable to access trusted doctors, specialists or hospitals outside their network. 

Older Americans are far from a uniform group. Their health, medications and financial circumstances vary dramatically. Yet H.R. 3467 assumes everyone will benefit from being placed in the cheapest available plan. 

While Medicare Advantage plans can provide valuable perks such as dental, hearing and fitness benefits, they often impose narrow provider networks, prior-authorization hurdles and higher out-of-pocket costs when care is needed most. If an older adult doesn’t realize they’ve been automatically enrolled or assumes they can switch later, they could discover the hard way that their longtime cardiologist, oncologist or local hospital isn’t covered.  

This bill doesn’t simplify Medicare; it substitutes an algorithm’s decision for an informed human choice. 

Currently, Medicare beneficiaries can review or change coverage annually during open enrollment. That flexibility is essential: people’s health and finances change. But H.R. 3467 would remove that freedom for three years after auto-enrollment. 

This rigidity will hurt those most in need: people with cognitive impairments, low digital literacy or limited access to trusted advisers. Many already struggle with overwhelming marketing and misinformation from insurers. A multi-year lock-in could make correcting an honest mistake nearly impossible. 

Imagine being 72, recently diagnosed with cancer, and realizing your plan doesn’t cover your preferred specialist — then learning you can’t change it for two more years. That’s not a “benefit”; it’s a bureaucratic trap. 

And the fallout won’t stop with the individual enrollees. Family caregivers, already juggling appointments, medications and appeals, will face greater strain when a loved one is locked into an unsuitable plan. Nearly one in five Americans now provides unpaid care to an adult aged 50 or older. Instead of easing their workload, this bill would multiply their stress. 

When Medicare Advantage plans deny coverage or restrict networks, caregivers often spend hours on the phone appealing decisions. A three-year lock-in ensures those frustrations will persist, with few options for relief.

Auto-enrollment isn’t the only concerning part of H.R. 3467. The bill also includes major structural reforms that could reshape Medicare behind the scenes. It transitions Medicare Advantage plan payments to a capitated model beginning in 2028, restricts risk-adjustment calculations to diagnoses recorded via face-to-face or telehealth visits within two years, and integrates hospice care into coverage — reversing Medicare’s long-standing “carve-out” that allowed flexibility and choice for end-of-life care. These changes could fundamentally shift who controls care decisions, moving power from patients and doctors to insurers. 

If Congress genuinely wants to improve Medicare, it should focus on informed choice, transparency and support — not on automatic defaults. Expanding State Health Insurance Assistance Programs would ensure beneficiaries receive one-on-one counseling before enrolling. Requiring clear, plain-language comparisons between Medicare Advantage and traditional Medicare would empower consumers. Publishing plan denial and out-of-network rates would help older adults make informed choices. Finally, expanding geriatric care coordination and caregiver education would reduce confusion and strengthen families’ ability to manage care. 

These reforms empower rather than entrap. They respect the complexity of aging and the individuality of every older adult. 

This bill remains in committee and has not advanced to a full House vote. There’s still time for lawmakers, Democrats and Republicans alike, to step back and reconsider the long-term consequences. Older Americans have earned the right to make informed decisions about their health care. They deserve choices rooted in understanding, not automation. Congress should protect that right, not sign it away under the guise of efficiency. 

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