Medicare agents need to stay informed about new legislative developments. The recent introduction of the "Choose Medicare Act" in June 2025 represents one of the most significant Medicare expansion proposals in years.
As a result, clients may start asking questions about this new option. Here's what agents need to know about the proposed Medicare Part E and how it could impact your business.
What is Medicare Part E?
Medicare Part E would be an entirely new Medicare option. It would allow people under 65 and employers to opt into Medicare coverage.
Unlike current Medicare eligibility rules, Part E would create a "public option" available to anyone.
The proposal was introduced by Representatives Jimmy Gomez (D-California) and Don Beyer (D-Virginia) in the House. Additionally, Senators Jeff Merkley (D-Oregon) and Chris Murphy (D-Connecticut) introduced companion legislation in the Senate.
Most importantly, this proposal would allow Medicare to compete directly with private health insurance plans.
Current Status of Medicare Part E Legislation
The Choose Medicare Act was introduced in both chambers of Congress in June 2025. The House version is designated as H.R. 3911 and the Senate version is S.2032.
However, agents should understand that this is still early-stage legislation.
For Medicare Part E to become reality, the bill would need to pass both the House and Senate. Then, it must be signed by the President – a process that typically takes considerable time and faces significant political hurdles.
Similar proposals have been introduced before. Previous versions of the Choose Medicare Act were introduced in 2021. However, they didn't advance to a vote.
What Are the Realistic Chances of Passage?
While Medicare Part E generates significant discussion, the practical likelihood of passage in the near term is extremely low. Here's why:
- Republican Control: With Republicans controlling both the House and Senate in 2025, Democratic-sponsored healthcare expansion bills face significant obstacles
- Historical Pattern: Similar Medicare expansion proposals have been introduced repeatedly over the years without advancing to votes
- Provider Opposition: Healthcare industry groups typically oppose Medicare expansion due to reimbursement concerns, creating powerful lobbying pressure against passage
Previous Track Record: The Choose Medicare Act has been introduced multiple times since 2021 without gaining traction. This suggests the proposal serves more as a policy marker for future debates rather than near-term legislation.
How Medicare Part E Would Work
If enacted, Medicare Part E would operate differently from traditional Medicare:
First, the Choose Medicare Act would make Medicare available through all state and federal health insurance marketplaces. It would also allow people to use Affordable Care Act (ACA) subsidies to help with payment.
Additionally, it would let employers of any size choose Medicare rather than private insurance to cover employees. It's worth noting that this wouldn't require them to get rid of their current insurance plans.
The new Medicare "Part E" option would be designed to pay for itself via premiums. As a result, it would allow Medicare to compete with private health insurance.
Finally, the bill would require coverage of the 10 essential health benefits in the ACA. This would be in addition to everything regular Medicare covers. Besides that, it would guarantee access to a full range of reproductive health services, including abortion.
Medicare Part E vs Medicare for All
Medicare Part E preserves choice and competition between public and private options, while Medicare for All would eliminate private insurance entirely.
For agents, this means Medicare Part E could potentially expand your market by creating new enrollment opportunities, while Medicare for All would fundamentally restructure the entire insurance industry.
Medicare Part E (Choose Medicare Act):
- Creates a public option that competes alongside private insurance
- Allows people to choose between Medicare Part E and private plans
- Maintains the existing insurance system while adding a government option
- Self-funded through premiums paid by enrollees
- Available through ACA marketplaces with subsidy eligibility
- Employers can choose to offer it instead of private insurance
Medicare for All:
- Would replace the entire private insurance system
- Creates a single-payer system where government is the only insurer
- Eliminates private health insurance (with limited exceptions)
- Funded through taxes rather than individual premiums
- Would phase out Medicare Advantage plans and employer-sponsored insurance
It's worth noting that Medicare for All legislation was also reintroduced in 2025 as separate bills (H.R. 3069 in the House and S. 1506 in the Senate).
Pros and Cons for the Insurance Market
Potential Benefits
Part E could provide more affordable coverage options for clients currently struggling with high individual market premiums, particularly those who don't qualify for ACA subsidies.
Increased competition would help lower private insurance premiums by giving Medicare the ability to compete directly with commercial plans.
Affordability is another target of the bill, with a cap on out-of-pocket spending in traditional Medicare and enhanced premium assistance that more people would qualify for. It would also allow Medicare to negotiate better prices for prescription drugs.
Significant Concerns
The biggest concern for everyone involves Medicare's historically lower reimbursement rates.
Private insurance rates for inpatient and outpatient hospital services averaged 199% of Medicare rates (KFF). This means providers typically receive about twice as much from private insurance as they do from Medicare.
Here's a real-world example: A friend of mine is an audiologist, and she typically breaks even or even loses money on Medicare and Medicaid patients, though she won't turn them away. The patients who use private insurance keep her practice profitable. It allows her to accept the lower government rates.
However, if everyone suddenly switched to Medicare, providers like her would face a difficult choice. They might need to limit Medicare patients or close their practices entirely. This scenario applies to many healthcare providers across different specialties.
What This Means for Medicare Agents
All of the talk about Medicare Part E doesn't mean a whole lot for agents at the moment.
This legislation is in its early stages and is very unlikely to go anywhere. However, it's always good to stay in the loop. At the very least, you'll be able to provide knowledgeable responses if clients ask about it.
If Medicare Part E eventually becomes law, it would likely phase in over several years. This would give all of us plenty of time to adapt.
Provider and Industry Reactions
Healthcare providers have historically opposed Medicare expansion proposals due to reimbursement concerns. Currently, physicians are experiencing a 2.83% Medicare payment cut in 2025, which went into effect January 1st.
Meanwhile, Medicaid fee-for-service payments for physician services are nearly 30 percent below Medicare payments. These are already well below commercial rates.
These payment differences explain why some providers, particularly specialists, limit Medicare patients or don't accept Medicare at all. This dynamic could worsen if Medicare Part E significantly expands Medicare enrollment.
Conclusion
Medicare Part E is an ambitious attempt to expand Medicare access. However, agents should view it as a long-term possibility rather than an immediate concern.
For now, focus on serving your current clients with existing Medicare options while staying informed about legislative developments. If Medicare Part E eventually becomes law, it would likely be implemented gradually.
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