Which specific Medicare rules or waivers did the Trump administration change between 2017 and 2020?
Executive summary
Between 2017 and 2020 the Trump administration pursued a mix of executive orders, finalized regulations and interim rules that reshaped Medicare policy largely by promoting Medicare Advantage (MA) plan flexibility, expanding telehealth and supplemental benefits in MA, altering payment and provider rules, and instituting price-transparency requirements—while some actions were proposals or invitations for states rather than finalized Medicare waivers [1] [2] [3] [4]. Critics point to related administrative moves (largely in Medicaid) and regulatory rollbacks that they say weaken access or oversight, but the core, specific Medicare changes in that period are in the CMS rules and executive directives cited below [5] [6].
1. Executive Order directing Medicare to adopt market-based reforms
An early, foundational action was Executive Order 13813 and a follow-on Executive Order instructing the HHS Secretary and CMS to adopt “market-based” recommendations to increase plan choices and encourage innovations such as Medicare Medical Savings Accounts, broader supplemental benefits, and faster coverage decisions after FDA approval—directives that set the administration’s regulatory agenda for Medicare between 2017 and 2020 [1].
2. Final rules expanding Medicare Advantage benefits, telehealth and enrollment flexibility
CMS finalized substantive changes to Medicare Advantage and Part D for 2021 that were announced in 2020: the agency expanded MA plans’ ability to offer telehealth and new supplemental benefits for chronically ill enrollees, increased MA options for rural areas, and opened MA enrollment for patients with End Stage Renal Disease (ESRD)—policies formalized in the Contract Year 2021 MA/Part D final rule and linked to the administration’s EOs [2].
3. COVID-era interim adjustments to Star Ratings and program timing
In response to the COVID-19 public health emergency CMS used an Interim Final Rule with Comment Period (CMS‑1744‑IFC) in March 2020 to adopt temporary changes to the 2021–2022 Star Ratings methodology to accommodate pandemic-related disruptions—an operational waiver-like action that changed how plan quality was measured during that period [2].
4. Payment and clinician-focused rule changes (Physician Fee Schedule and QPP)
The administration finalized revisions to the Medicare Physician Fee Schedule and the Quality Payment Program for Calendar Year 2020 that CMS described as reducing provider burden and valuing clinician time; those payment-rule changes are part of the concrete, finalized regulatory actions affecting Medicare payment policies in the 2017–2020 window [3].
5. Transparency rules and premium/payment outcomes for MA and Part D
The Trump administration promulgated aggressive price-transparency rules (the 2020 “Transparency in Coverage” framework) and promoted policies the administration characterized as driving down Medicare Advantage and Part D premiums—CMS press releases report multi-year declines in average MA and Part D premiums and improvements in advertised plan choice and star ratings between 2017 and 2020 [4] [7] [8].
6. Proposals, incentives and the space of waivers—what was invited vs. what was a Medicare waiver
Some high-profile administrative moves in this period were invitations or proposals rather than Medicare-specific statutory waivers: CMS encouraged states to pursue demonstration projects mainly in Medicaid (block-grant or work-requirement style waivers), and policy analyses predicted possible deregulatory choices for MA (e.g., loosening requirements tied to the two‑midnight rule or utilization review standards), but these were largely proposed regulatory directions or state‑targeted waiver invitations rather than universal Medicare waivers finalized in 2017–2020 [6] [9] [5].
7. Critiques, limits and what remains uncertain in reporting
Critics—most prominently the Center on Budget and Policy Priorities—argued the administration weakened access and oversight in related programs and used guidance to allow state demonstrations that could undercut coverage (primarily Medicaid), and discussions about larger Medicare structural changes were often rhetorical or programmatic aims rather than concrete waivers enacted for Medicare beneficiaries during 2017–2020; reporting and agency documentation confirm finalized CMS changes (MA benefits, telehealth, payment rules, star-rating adjustments, transparency rules) but do not show sweeping Medicare statutory waivers in that period [5] [2] [1].