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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