Medicare is one of those things nobody thinks about until they have to, and then suddenly, it’s the most important thing in the world. Back in October 2019, while everyone was arguing about "Medicare for All," a massive shift happened right under our noses. President Trump signed Executive Order 13890, titled "Protecting and Improving Medicare for Our Nation's Seniors."
It sounds like standard political fluff, right? Honestly, it wasn't.
This order basically drew a line in the sand. It wasn't just about administrative tweaks; it was a loud, clear bet on private competition over government-run healthcare. If you've noticed your Medicare Advantage options exploding lately or seen more "telehealth" ads than you can count, you're looking at the ripple effects of this specific move.
The Core Philosophy: Advantage vs. Traditional
For decades, Medicare was pretty much one thing: the government pays the doctor (Fee-for-Service). But then Medicare Advantage (Part C) showed up—private plans that manage your care.
Trump’s order was designed to tip the scales.
The goal was to make Medicare Advantage (MA) so attractive that seniors would choose it over traditional Medicare. It directed the Department of Health and Human Services (HHS) to make MA plans more flexible. We’re talking about things like "cash-back" rebates for choosing high-value care and medical savings accounts that actually make sense for a retiree's budget.
The logic is simple: competition drives down prices. Or at least, that’s the theory. Critics, however, often argue that this "privatization" drains money from the traditional system that millions of people still rely on. It’s a classic tug-of-war between market efficiency and a guaranteed public safety net.
Slashing the "Paperwork Tax" for Doctors
One of the most frustrating things about healthcare is that your doctor spends half your appointment typing on a computer. You’ve seen it. You’re trying to explain your hip pain, and they’re battling a drop-down menu.
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The trump medicare executive order took a direct shot at this.
It ordered a "comprehensive review" of regulatory billing requirements. The idea was to eliminate "burdensome" rules that don't actually help patients but keep doctors stuck in the office until 9:00 PM doing data entry. Specifically, it looked at:
- Supervision Requirements: Letting Nurse Practitioners (NPs) and Physician Assistants (PAs) do more of what they’re trained for without a doctor hovering over them.
- Site Neutrality: Why should the same shot cost $50 at a clinic but $250 at a hospital? The order pushed for "site-neutral" payments so you don't get penalized just because of the building you walked into.
- Approval Speed: Cutting the lag time between when the FDA approves a new medical device and when Medicare actually agrees to pay for it.
Why the "Scope of Practice" Debate Matters
This is where things got a bit spicy in the medical community. By encouraging NPs and PAs to practice at the "top of their profession," the order sought to fix the doctor shortage, especially in rural areas. But some physician groups weren't thrilled. They argued that "coordinated care" needs a doctor at the helm to ensure safety. It’s a nuanced debate that still hasn't been fully settled in 2026.
Telehealth: The Quiet Revolution
We take it for granted now, but before 2020, getting Medicare to pay for a video call was like pulling teeth.
The 2019 order set the stage for the massive telehealth explosion we saw during the pandemic. It didn't just suggest telehealth; it demanded that HHS adjust "network adequacy" rules to account for it. Basically, it told insurance companies: "If you offer great video-doc options, we’ll count that toward your ability to serve a specific area."
This was a game changer for people in the middle of nowhere who had to drive three hours just to see a specialist for a 15-minute check-in.
Real Money: The $35 Insulin Cap and Pricing
You can't talk about Trump's Medicare moves without mentioning the "Most-Favored-Nation" idea.
The executive order laid the groundwork for trying to tie what Medicare pays for drugs to the lower prices paid in other wealthy countries. It was a "hit 'em where it hurts" approach to Big Pharma. While many of these specific rules faced massive legal battles, the momentum eventually led to the Part D Senior Savings Model, which capped insulin at $35 per month for many seniors.
Even as we sit here in 2026, that $35 cap remains a benchmark for what "affordable" looks like. It’s one of those rare policy wins that people actually felt in their wallets.
What Actually Happened? The Results
Policy is one thing; reality is another.
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Since the order was signed, Medicare Advantage enrollment has skyrocketed. More than half of all eligible seniors are now on private MA plans.
But it’s not all sunshine. We’ve seen reports of "upcoding," where private plans make patients look sicker on paper to get higher payments from the government. The 2019 order's push for "market-based approaches" definitely gave seniors more choices—like dental and vision coverage that traditional Medicare doesn't offer—but it also made the system way more complex to navigate.
Actionable Insights: How to Navigate This Now
If you’re currently on Medicare or helping a parent manage theirs, the legacy of this executive order means you have more homework than your parents did.
- Audit Your "Extra" Benefits: Many Medicare Advantage plans now offer "non-medical" benefits like grocery cards or transportation. These exists because the 2019 order allowed plans to get creative. Check your Evidence of Coverage (EOC) annually; these perks change fast.
- Demand Telehealth Access: If your doctor says they don't "do" video visits, find a new one. The regulatory barriers are largely gone. You have the right to convenient care.
- Watch the "Site of Service": Before scheduling a procedure, ask if it can be done in an ambulatory surgery center instead of a hospital. Thanks to site-neutrality pushes, your co-pay could be significantly lower.
- Use the "Medicare Plan Finder" Tool: With the explosion of private options, the difference between the "best" and "worst" plan in your zip code can be thousands of dollars. Never just let your plan auto-renew without checking the competition.
The 2019 trump medicare executive order wasn't just a piece of paper; it was a pivot point. It shifted Medicare from a "one-size-fits-all" government program toward a competitive marketplace. Whether that's "better" depends entirely on how well you know how to shop the system.