What’s the difference between “single payer” and “Medicare for All”?

At CAPP, we believe that every person should receive high-quality, affordable health care through a coordinated, value-based delivery system. As Medicare for All calls have become commonplace in health policy conversation, the nuances of each plan are important for the health care system. Here are simple explanations and information about what the options mean.

Medicare For All	Public Option	Medicare Buy-in	Medicaid Buy-in
Overview: Creates a single national health insurance program, administered by the federal government, for all US residents	Overview: Federal public plan option offered to eligible individuals; would compete with other private insurance plans	Overview: Provides an option for individuals to buy into Medicare	Overview: Provides an option for individuals to buy into a state’s Medicaid program
Provider Payments: Typically fee-for-for-service (FFS)	Provider Payments: Typically FFS — would not fall below current Medicare payment rates	Provider Payments: Follows medicare payment rates (FFS)	Provider Payments: States required to pay primary care providers at least medicare rates (FFS)
Provider Participation: All state-licensed and certified providers	Provider Participation: Medicare (and some participating Medicaid) participating providers	Provider Participation: Medicare participating providers	Provider Participation: Medicaid providers, including medicaid managed care organizations
Eliminates Private Insurance? Yes	Eliminates Private Insurance? No	Eliminates Private Insurance? No	Eliminates Private Insurance? No
Financed: Taxes No premiums and limited cost sharing, if any	Financed: Premiums and cost sharing Annual out-of-pocket limit cannot exceed the ACA limit	Financed: Premiums and cost sharing No out-of-pocket limit, unless beneficiary is enrolled in Medicare Advantage or ACA cost sharing applies	Financed: Premiums and cost sharing Annual out-of-pocket limit cannot exceed the ACA limit
Example: Senate Sen Sanders S.1129 Example: House Rep. Jayapal H.R.1384	Example: Senate Sen. Cardin S.3 Example: House Rep. Schakowsky H.R.2085	Example: Senate Sen. Stabenow S.470 Example: House Rep. Higgins H.R.1346	Example: Senate Sen. Schatz S.489 Example: House Rep. Lujan H.R.1277

Medicare For All	Public Option
Overview: Creates a single national health insurance program, administered by the federal government, for all US residents	Overview: Federal public plan option offered to eligible individuals; would compete with other private insurance plans
Provider Payments: Typically fee-for-for-service (FFS)	Provider Payments: Typically FFS — would not fall below current Medicare payment rates
Provider Participation: All state-licensed and certified providers	Provider Participation: Medicare (and some participating Medicaid) participating providers
Eliminates Private Insurance? Yes	Eliminates Private Insurance? No
Financed: Taxes No premiums and limited cost sharing, if any	Financed: Premiums and cost sharing Annual out-of-pocket limit cannot exceed the ACA limit
Example: Senate Sen Sanders S.1129 Example: House Rep. Jayapal H.R.1384	Example: Senate Sen. Cardin S.3 Example: House Rep. Schakowsky H.R.2085

Medicare Buy-in	Medicaid Buy-in
Overview: Provides an option for individuals to buy into Medicare	Overview: Provides an option for individuals to buy into a state’s Medicaid program
Provider Payments: Follows medicare payment rates (FFS)	Provider Payments: States required to pay primary care providers at least medicare rates (FFS)
Provider Participation: Medicare participating providers	Provider Participation: Medicaid providers, including medicaid managed care organizations
Eliminates Private Insurance? No	Eliminates Private Insurance? No
Financed: Taxes No out-of-pocket limit, unless beneficiary is enrolled in Medicare Advantage or ACA cost sharing applies	Financed: Premiums and cost sharing Annual out-of-pocket limit cannot exceed the ACA limit
Example: Senate Sen. Stabenow S.470 Example: House Rep. Higgins H.R.1346	Example: Senate Sen. Schatz S.489 Example: House Rep. Lujan H.R.1277

Medicare For All
Overview: Creates a single national health insurance program, administered by the federal government, for all US residents
Provider Payments: Typically fee-for-for-service (FFS)
Provider Participation: All state-licensed and certified providers
Eliminates Private Insurance? Yes
Financed: Taxes No premiums and limited cost sharing, if any
Example: Senate Sen Sanders S.1129 Example: House Rep. Jayapal H.R.1384

Public Option
Overview: Federal public plan option offered to eligible individuals; would compete with other private insurance plans
Provider Payments: Typically FFS — would not fall below current Medicare payment rates
Provider Participation: Medicare (and some participating Medicaid) participating providers
Eliminates Private Insurance? No
Financed: Premiums and cost sharing Annual out-of-pocket limit cannot exceed the ACA limit
Example: Senate Sen. Cardin S.3 Example: House Rep. Schakowsky H.R.2085

Medicare Buy-in
Overview: Provides an option for individuals to buy into Medicare
Provider Payments: Follows medicare payment rates (FFS)
Provider Participation: Medicare participating providers
Eliminates Private Insurance? No
Financed: Premiums and cost sharing No out-of-pocket limit, unless beneficiary is enrolled in Medicare Advantage or ACA cost sharing applies
Example: Senate Sen. Stabenow S.470 Example: House Rep. Higgins H.R.1346

Medicaid Buy-in
Overview: Provides an option for individuals to buy into a state’s Medicaid program
Provider Payments: States required to pay primary care providers at least medicare rates (FFS)
Provider Participation: Medicaid providers, including medicaid managed care organizations
Eliminates Private Insurance? No
Financed: Premiums and cost sharing Annual out-of-pocket limit cannot exceed the ACA limit
Example: Senate Sen. Schatz S.489 Example: House Rep. Lujan H.R.1277

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