What’s at Stake in 2026: Administrative Barriers

Ensuring access to care does not start with expanding eligibility and lowering costs. A combination of complicated rules, onerous requirements, and missing or conflicting information creates systems where people who need and qualify for coverage cannot jump through the hoops to access that support. These administrative barriers are often the result of intentional policy choices that make accessing care more difficult—sometimes difficult enough to make people give up in the process.

Barriers Affecting Medicare

Medicare enrollment and appeals require beneficiaries to take active—and often repeated—steps to obtain or keep care in situations where automated processes would be appropriate and more efficient. First-time enrollment in Medicare is not automatic for people who are not receiving Social Security retirement benefits or Railroad Retirement benefits at 65, a category that accounts for a growing number of older adults. Missing this deadline can saddle individuals with permanent penalties for late enrollment. Further, the frequent changes in Medicare Advantage (MA) plans and Part D formularies mean MA beneficiaries need to assess their benefits and compare plans every year to ensure they have the coverage they need. With the proliferation of MA plans in recent years, this is a substantial and burdensome task for beneficiaries to take on.

Medicare enrollment and appeals require beneficiaries to take active—and often repeated—steps to obtain or keep care.

MA and Part D plan coverage denials add administrative obstacles to a financial burden. Many people who receive denials have to pay out of pocket for their care or prescription drugs while navigating a time-consuming, multi-step appeals process. Thousands of improper coverage denials per year plunge people into this process unnecessarily and with little support or information.

Barriers Affecting Medicaid

Medicaid administrative barriers built on periodic redeterminations or reporting requirements contribute to beneficiary churn, which is unnecessary and repeated loss of coverage. Churn endangers people’s health and financial situations.

These administrative barriers strip coverage from people not by changing eligibility criteria but by adding unnecessary and punitive deadlines.

Redeterminations require beneficiaries to recertify their income and asset information multiple times a year, though older adults and people with disabilities are more likely to have fixed incomes year after year. Work reporting rules similarly require beneficiaries to consistently prove their employment or exemption status, despite the fact that most people subject to these rules are exempt. These administrative barriers strip coverage from people not by changing eligibility criteria but by adding unnecessary and punitive deadlines. They are also costly for insurance plans and states to address.

Medicare Savings Programs and Dual-Enrolled Beneficiaries

Dual Medicare–Medicaid beneficiaries experience double the administrative burdens because the systems are not adequately integrated. Medicare Savings Programs (MSPs) are Medicaid programs that help Medicare beneficiaries pay out-of-pocket expenses, and enrollment in an MSP (which comes with Extra Help assistance for Part D costs) saves individuals an average of $8,400 a year. But due to administrative barriers that complicate enrollment, eligibility requirements, and recertifications, MSPs have consistently been underenrolled.

Dual Medicare–Medicaid beneficiaries experience double the administrative burdens, because the systems are not adequately integrated.

In 2023, New York raised income limits for MSP enrollment—in response to a coalition of advocates including the Medicare Rights Center—to include nearly 300,000 more New Yorkers. Effective in 2026, New York eased a major administrative barrier by automating MSP enrollment based on existing income data from the state’s Extra Help applications.

Similarly, the Biden administration finalized a rule in 2023 to streamline MSP enrollment based on federal Supplemental Security Income and Extra Help data. The Centers for Medicare & Medicaid Services estimated that the final rule would help 860,000 more people enroll in MSPs. Enforcement of much of the rule, however, was halted by HR 1 in 2025. This means many administrative barriers to MSP access remain in place unless individual states take action to dismantle them.

Many administrative barriers to MSP access remain in place unless individual states take action to dismantle them.

Administrative barriers delay and complicate needed care, and they penalize older adults and people with disabilities for honest mistakes and factors outside of their control. Policies that remove these barriers can help ensure that the Medicare and Medicaid programs are truly reaching the people who need them.

View the fact sheet: What Administrative Barriers Mean for Older Adults and People With Disabilities.

View the series: What’s at Stake for Older Adults and People With Disabilities.