Well, this is not a big move and wouldn’t effect many. Mostly it’s the well to do and or healthy Medicare aged people that want to keep their SS benefits without being forced to go on Medicare. Right now, if you opt out of Medicare, you forfeit SS benefits.
So, one could use their HSA if they have enough money in it for coverage. They could buy private insurance if healthy enough or a health sharing plan.
Medicare is going to become increasingly more rationed as the program is financially squeezed. There is also more government control over information which will result in administrative manipulation of care and individual behavior.
Honestly, I think they’ll simply up some of the payment levels an make it solvent longer into the future.
Wish they’d start privatizing it.