Recent remarks from Centers for Medicare and Medicaid Services (CMS) Director of Medicare Chris Klomp have reinvigorated conversations about how new Medicare beneficiaries should enter the program. Klomp reportedly said the administration is considering whether some new beneficiaries should be automatically enrolled in Medicare Advantage or other managed care arrangements. Klomp’s remarks move policymaking toward a more patient-centric health care program, though this proposal suffers from the same shortcoming as the current model: Neither auto-enrollment approach is truly beneficiary-centered. But an active-selection model can be. 

The chief strength of active selection – requiring the newly eligible to affirmatively choose between traditional Medicare and Medicare Advantage, rather than being passively routed into a default program – is operational neutrality. Today’s system gives traditional Medicare the advantage of inertia. A Medicare Advantage default pathway would simply reverse the bias and use the same inertia to push seniors into private managed care. An active selection approach would require the federal government to present the decision tree clearly, explain the tradeoffs, and allow a beneficiary to choose the coverage model that best matches their medical, financial, and personal circumstances.

The ability to choose matters because the two programs are not interchangeable. Traditional Medicare generally offers broad provider access nationwide and does not rely on the same degree of utilization management that characterizes private plans. Medicare Advantage, by contrast, is offered by private insurers, often uses provider networks, and often includes prescription drug coverage and supplemental benefits in a more integrated package. Traditional Medicare typically requires a beneficiary to make additional decisions about Part D and, for many, Medigap coverage. CMS itself presents these as distinct coverage pathways with differences in access, costs, and benefit design.

These distinctions are precisely why passive enrollment is a poor fit for modern Medicare. The choice between traditional Medicare and Medicare Advantage is not merely administrative. It is a consequential decision about how care will be financed, managed, and accessed. When the options differ this much, government should not select one for a passive enrollee. The enrollee should be invested in their own health care.

An active-selection model would not detract from Medicare’s mission and would better reflect the current Medicare marketplace. After 20 years, Medicare Advantage is not a small alternative that needs structural help to compete. More than half of eligible Medicare beneficiaries were enrolled in Medicare Advantage in 2025, and the average beneficiary has access to 39 Medicare Advantage plans in 2026, including 32 plans with prescription drug coverage. Medicare Advantage is already widely available and deeply embedded in the program. It does not need the government to nudge additional enrollment through automatic assignment. If it is the better product for a given senior, it should win because that senior actively chose it.

Active selection would also help force greater attention to tradeoffs that are too often discovered only after someone gets sick. Medicare Advantage can be appealing for good reason: Lower premiums, an out-of-pocket maximum, and bundled extra benefits are meaningful selling points. But those advantages are paired with utilization management tools that can materially shape access to care. KFF has noted that virtually all Medicare Advantage enrollees are in plans that require prior authorization for some services. Those features may be acceptable, or even attractive, for many beneficiaries. But they are too important to be buried inside a default.

The same is true on the traditional Medicare side. Broad provider access and relative freedom from network restrictions can be especially valuable for beneficiaries with complex conditions, extensive specialist use, seasonal residence patterns, or a preference for maximum flexibility. But traditional Medicare can also expose beneficiaries to a more fragmented set of coverage decisions, including increased cost sharing, separate enrollment in Part D, and the need for possible supplemental coverage.

Active selection is valuable because it acknowledges that both models have real strengths and real tradeoffs. It could also reduce the likelihood that beneficiaries drift into long-term consequences they did not fully understand when first eligible. An active-selection model would also improve CMS governance incentives. It would have more robust information based on active-selection data through which to improve beneficiary notices, comparison tools, counseling, and enrollment interfaces. In other words, the government would have to help people understand the decision instead of making it for them.

The case for active selection, then, is not ideological. It is practical. Traditional Medicare and Medicare Advantage each offer legitimate advantages, and neither should receive an artificial edge through default enrollment policy. Policymakers should resist the temptation to replace one bias with another. A better reform would require an affirmative choice. That would be more neutral, more transparent, and more consistent with the reality of what Medicare has become.