It’s official. After a shaky road that had many public officials questioning his understanding of healthcare programs like Medicare and Medicaid, Robert F. Kennedy Jr has been confirmed as the new head of the U.S. Department of Health and Human Services (HHS).
The Senate voted 52 to 48 for Kennedy, a 71-year-old environmental lawyer and author who has advocated against certain vaccines. Senator Mitch McConnell (R-KY), who suffered from polio as a child before the polio vaccine was available, voted against Kennedy.
As HHS secretary, Kennedy has the power to change health care for younger Americans and retirees alike. Here’s what might happen to Medicare under his leadership.
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As part of his recent campaign, President Donald Trump stated, “We will protect Medicare and ensure seniors receive the care they need without being burdened by excessive costs.”
The nonpartisan Committee for a Responsible Federal Budget confirmed that Trump’s budgetary proposals for Medicare during his initial presidential term were proposals to reduce the cost of Medicare — not proposals to reduce the benefits older Americans receive. Based on this, it’s unlikely that Kennedy will actively seek to cut Medicare benefits.
2. Better integration of Medicare and Medicaid? Maybe
While Medicare eligibility hinges mainly on age, Medicaid is primarily geared to the poor, with eligibility depending on meeting state income-related requirements. An estimated 12 million Americans are dually eligible for both Medicare and Medicaid.
During his Jan. 29 Senate confirmation hearing, Kennedy stated that “dual eligibles are not right now served very well under the system” and acknowledged the need for better integration of care. While Kennedy said he looked forward to consolidating the programs to improve care, he didn’t have a concrete plan and admitted that integration would be difficult.
3. Expanding access to Medicare Advantage
As of 2024, an estimated 33.8 million Americans, or roughly 55% of the Medicare population, received health coverage through Medicare Advantage. Private insurers provide these plans and must offer at least the same level of coverage as original Medicare. Medicare Advantage enrollment has also doubled over the past decade.
Many seniors choose Medicare Advantage plans because they commonly offer supplemental benefits beyond what original Medicare covers, such as dental care, eye exams, and hearing aids and testing. A good number of Medicare Advantage plans also offer fitness and wellness benefits.
As a Medicare Advantage enrollee himself, Kennedy knows these privately run plans have benefits. He also said he thinks most people would prefer coverage under Medicare Advantage but cannot afford it. Some Medicare Advantage plans have $0 monthly premiums, but they usually come with higher deductibles and other costs.
Although Medicare Advantage plans are popular, they receive a high number of complaints from beneficiaries. In general, Medicare Advantage customers complain about slow care approvals and denial of prior authorizations for care.
Finally, it’s unclear how emphasizing Medicare Advantage would save the government and U.S. taxpayers money. Advantage programs reportedly cost 22% more per beneficiary than traditional Medicare, likely because Advantage companies must generate a profit.
4. Vaccine coverage under Medicare
Currently, Medicare covers all adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices, with no out-of-pocket costs to enrollees. But with a history of anti-vaccine activism, it’s unclear as to what changes Kennedy might make in the context of vaccine coverage for older Americans.
In a November 2024 NPR interview, Kennedy said, “We’re not going to take vaccines away from anybody. We are going to make sure that Americans have good information.” There’s a good chance vaccine coverage under Medicare will not change in the near term. That said, many in the scientific community are concerned about Kennedy’s long-term vaccine plans.
5. Prescription drug coverage under Medicare
The Inflation Reduction Act (IRA), passed during the Biden administration, sought to lower out-of-pocket healthcare costs for older Americans. One big change it made was capping the price of insulin at $35 per month, as well as putting a $2,000 annual cap on out-of-pocket costs for Medicare Part D enrollees. The IRA also paved the way for drug price negotiations, leading to lower costs.
On January 20, 2025, President Trump revoked Executive Order 14087, titled “Lowering Prescription Drug Costs for Americans.” This order complemented the IRA and supported lower prescription costs for Medicare enrollees. In light of this, uncertainty abounds regarding future prescription drug costs for older Americans.
To be clear, Trump’s move shouldn’t actually impact current Medicare drug prices, as that would require overturning the IRA. Congress could partially or fully repeal the IRA through legislation, but that hasn’t happened. The Trump administration clarified that the IRA program would continue negotiating Medicare drug prices.
Meanwhile, Kennedy has long supported measures to lower drug costs for Americans of all ages. In a September 2024 op-ed in The Wall Street Journal, Kennedy wrote, “Legislators should cap drug prices so that companies can’t charge Americans substantially more than Europeans pay.”
During the Jan. 29 Senate confirmation hearing, Kennedy reiterated the need for drug reform and lower prices. However, without a new executive order allowing HHS to explore options for drug reform, it’s unclear where drug prices for Medicare enrollees will go.
Older Americans can hope that as part of Kennedy’s pledge to make America healthy again, he’ll continue to support drug price caps and limits on out-of-pocket spending for Part D and Medicare Advantage plan participants.
All told, any changes Kennedy makes to Medicare have the potential to impact millions of people’s retirement. We’ll need to stay tuned.