ThinkTankWeekly

Options for modernization of traditional Medicare

Brookings | 2026-08-08 | health

Topics: Trade, United States

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English Summary

The Brookings analysis argues that Traditional Medicare's benefit design is outdated and insufficient compared to Medicare Advantage (MA), primarily due to its lack of a comprehensive Out-of-Pocket (OOP) cap for Parts A and B. This absence exposes beneficiaries to catastrophic financial risk, forcing many to purchase complex supplemental insurance plans that increase overall program costs and complexity. To modernize the system, the paper recommends implementing an OOP cap across both parts of Medicare. Adopting this cap would significantly improve Traditional Medicare's actuarial value, reduce coverage gaps for high-cost patients, and achieve greater parity with MA offerings.

中文摘要

布魯金斯(Brookings)的分析指出,相較於優勢醫療保險(Medicare Advantage, MA),傳統醫療保險(Traditional Medicare)的給付設計已過時且不足。其主要症結在於缺乏涵蓋A部和B部的全面性自付額上限(Out-of-Pocket Cap)。這種缺失使受益人面臨災難性的財務風險,迫使許多人購買複雜的補充保險計畫,進而提高整體計畫成本與複雜度。為現代化此系統,本文建議在醫療保險的兩部分實施自付額上限。採用此上限將能顯著提升傳統醫療保險的精算價值(actuarial value),縮小高成本病患的保障缺口,並使其服務水平達到與MA提供的產品更高的對等性。

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