What Project 2025 says about Medicare
Project 2025 is a policy document released by The Heritage Foundation in 2024 that outlines proposed changes to federal programs, including Medicare. The document suggests shifting Medicare toward a model where beneficiaries receive fixed dollar amounts to purchase coverage from private insurers, rather than the current system where Medicare directly provides or pays for care. It also proposes raising the may be able to access age, adjusting how much beneficiaries pay out of pocket, and reducing federal spending on the program.
These are proposals only — they are not law, and no changes to Medicare have been enacted based on this document. Understanding what Project 2025 proposes helps you stay informed about policy conversations that may affect your coverage in the future, even if those changes take years to develop or never happen at all.
Key Takeaways
- Project 2025 proposes converting Medicare from a defined-benefit program (where the government guarantees coverage) into a defined-contribution program (where beneficiaries receive a fixed dollar amount to buy private insurance).
- The document suggests raising the Medicare may be able to access age from 65 to a higher age, which would delay coverage for some people currently turning 65.
- Project 2025 proposes increasing out-of-pocket costs for beneficiaries through higher deductibles, copayments, and premium contributions.
- The proposals aim to reduce federal spending on Medicare, though the document does not detail exactly how much savings would result or how they would be distributed.
- No changes based on Project 2025 have been made to Medicare; these remain policy proposals under discussion.
The shift from defined-benefit to defined-contribution
Currently, Medicare operates as a defined-benefit program. That means the federal government guarantees a specific set of benefits — hospital care, doctor visits, prescription drugs — and pays providers directly or reimburses you for covered services. You know what your benefits are because the law defines them.
Project 2025 proposes converting Medicare to a defined-contribution model. Under this approach, instead of guaranteeing specific benefits, the government would give each beneficiary a fixed amount of money each year. You would then use that amount to purchase a private insurance plan from a marketplace. If the plan you choose costs more than your allotment, you pay the difference. If it costs less, you keep the savings — or the money is not available to you.
This is a fundamental restructuring. In the current system, if a new treatment becomes available and is medically necessary, Medicare covers it (if it meets coverage rules). In a defined-contribution system, your coverage depends on which plan you buy and whether that plan includes the treatment, not on what Medicare guarantees.
Proposed changes to may be able to access age
Project 2025 suggests raising the age at which people become may be able to access for Medicare. Currently, most people become may be able to access at 65. The document does not specify an exact new age, but proposes a gradual increase over time.
If this change were enacted, people turning 65 in future years would not when ready may have access to for Medicare. They would need to wait longer or find other coverage — through an employer, the individual market, or another program — until they reached the new may be able to access age. This would particularly affect people who retire at 65 and lose employer coverage.
Raising the may be able to access age is separate from the defined-contribution proposal. Both could happen together, or one could be adopted without the other.
Out-of-pocket cost increases
Project 2025 proposes increasing what beneficiaries pay directly for care. This could happen through higher deductibles (the amount you pay before insurance kicks in), higher copayments (the fixed amount you pay per visit or service), or higher premiums (the monthly cost of coverage).
The document does not specify exact dollar amounts or which costs would increase most. The goal stated in the proposal is to reduce federal spending by shifting more of the cost burden to beneficiaries and to encourage people to be more cost-conscious when using healthcare.
Under the current Medicare system, beneficiaries already pay premiums, deductibles, and copayments. Project 2025 proposes making these costs larger, though the exact structure would depend on how any legislation was written.
Proposed federal spending reductions
A central aim of Project 2025 is to reduce federal spending on Medicare. The document argues that the current program is unsustainable and that costs must be controlled. The proposals outlined — shifting to defined contributions, raising the may be able to access age, and increasing beneficiary costs — are intended to achieve that reduction.
The document does not provide detailed projections of how much money would be saved, how those savings would be calculated, or how the savings would be used. It also does not specify whether the savings would come from reduced benefits, lower provider payments, or a combination of both.
Reducing federal spending on Medicare would mean either beneficiaries pay more, providers receive less, or both. Project 2025 emphasizes beneficiary cost-sharing and market-based competition among private insurers as the mechanism, but does not detail provider payment changes.
What Project 2025 does not propose
Project 2025 does not propose eliminating Medicare entirely. It proposes restructuring it. Beneficiaries would still have a program designed for people 65 and older (or younger people with disabilities or end-stage renal disease, depending on how may be able to access rules changed).
The document also does not propose changes to Social Security, though Social Security and Medicare are often discussed together because many people receive both. Project 2025 addresses Social Security separately.
Finally, Project 2025 is not a law or regulation. It is a policy proposal. No changes to Medicare have been enacted based on this document, and it is unclear whether any of these proposals will become law or how they might be modified if they do.
How Project 2025 differs from current Medicare
The table below shows how Project 2025's main proposals would differ from how Medicare currently works:
| Feature | Current Medicare | Project 2025 Proposal |
|---|---|---|
| Benefit structure | Defined benefits set by law; government guarantees coverage | Defined contribution; fixed dollar amount per beneficiary to buy private insurance |
| may be able to access age | 65 (with exceptions for disability) | Proposed increase to a higher age, phased in gradually |
| Out-of-pocket costs | Premiums, deductibles, copayments set by law | Proposed increases to premiums, deductibles, and copayments |
| Insurance model | Government-run program with private supplemental options | Private insurance marketplace with government contribution |
| Federal spending | Grows with beneficiary population and healthcare costs | Proposed reduction through cost-shifting to beneficiaries |
Frequently Asked Questions
Will Project 2025 changes happen to my Medicare?
Not when ready. Project 2025 is a proposal, not law. Any changes would require Congress to pass legislation and the President to sign it. Even if that happens, most proposals include phase-in periods, so changes would likely affect people turning 65 in future years before affecting current beneficiaries. It is important to stay informed about policy developments, but your current Medicare coverage is not changing based on this document alone.
What is The Heritage Foundation?
The Heritage Foundation is a conservative think tank that publishes policy proposals. Project 2025 represents the Foundation's policy recommendations, not official government policy. Many organizations across the political spectrum publish policy proposals; this is one of them. The document was created to inform policy discussions, but it does not represent a consensus view or official government direction.
If Medicare becomes a defined-contribution program, will I have to switch insurance?
That would depend on how any legislation was written. If the change were enacted, you would likely have options to choose from in a marketplace, similar to how the Affordable Care Act marketplace works. You might be able to stay with a plan similar to your current coverage, or you might need to select a new plan. The exact process would be determined by Congress if this proposal ever became law.
Would my benefits change if the may be able to access age increased?
If you are already on Medicare, an increase to the may be able to access age would not affect you. If you are approaching 65 in the future, a higher may be able to access age would delay when you become may be able to access. You would need to find other coverage — through an employer, the individual market, or Medicaid — until you reached the new age. People with disabilities or end-stage renal disease have different may be able to access rules and would need to understand how those might change.
Where can I learn more about Project 2025?
The Heritage Foundation published the full Project 2025 document on its website. You can also find summaries and analyses from policy organizations across the political spectrum. Your local Area Agency on Aging or a Medicare counselor through the State Health Insurance information Program (SHIP) can discuss how policy proposals might affect you personally.