Ryan would turn Medicare into a “premium-support” program for workers currently under the age of 55, beginning in 2023. In this system, the government would provide seniors with a fixed sum of money every year that they would use to buy a health plan through shopping sites dubbed “Medicare exchanges." Traditional fee-for-service Medicare would be one of the available options.
Low-income seniors and seniors with existing health problems would get more cash in premium supports. Higher-income seniors would get less, as Medicare Parts B and D would be means-tested under Ryan’s plan. After 2023, overall annual federal spending on Medicare would be capped at GDP growth plus 0.5 percent.
Ryan and his supporters maintain that such reforms are necessary to ensure Medicare’s health in coming decades. Critics say this is a “voucher” program that would inevitably shift more health-care costs onto seniors’ backs. They point to a Congressional Budget Office (CBO) analysis that concluded that “beneficiaries participating in the new premium support program would bear a much larger share of their health-care costs than they would under the traditional program."