Phase 2: Wave 1: seniors, near-seniors, and children · Step 2.1

Upgrade Medicare enrollees into UHP

Every concrete action this step requires, who is responsible, and when it happens relative to enactment.

#	Action	Owner	When	Trade-off
2.1.1	Convert Medicare Beneficiary Identifiers into UHP numbers (same number, new card).	UHA	Month 15–18 of build	Reusing Medicare numbers avoids re-enrollment but ties UHP identity to Medicare's legacy identifier system.
2.1.2	Stop Part B premium deductions from Social Security checks.	SSA	Day 1	Ending Part B deductions raises seniors' Social Security checks immediately but removes a revenue stream the moment UHP begins.
2.1.3	Medicare Advantage: no new contract year after Year 1. MA enrollees stay in their plan for Year 1 (to avoid mid-year disruption), and plans are paid on UHP rates through capitation. Plans end on the last day of Year 1.	UHA	Year 1	Letting MA run through Year 1 avoids mid-year disruption but pays MA overpayments for one more year.
2.1.4	Part D plans: drugs move to the national formulary on Day 1; Part D sponsors administer run-out claims for 90 days.	UHA	Day 1	Moving drugs to the national formulary on Day 1 ends plan-switching hassles but risks formulary gaps for some patients.
2.1.5	Medigap: policies terminate on Day 1; insurers refund unearned premiums pro rata within 60 days.	State regulators	Day 1	Terminating Medigap on Day 1 saves seniors money but abruptly ends a product millions chose.
2.1.6	Dual eligibles (Medicare + Medicaid, about 12M): UHP covers all medical and long-term services; state Medicaid's role ends except the MOE payment.	UHA / states	Day 1	Covering duals fully through UHP ends coordination problems but removes state control over their long-term care.
2.1.7	Mail every beneficiary a plain-language letter: what changes, what doesn't, and that their doctors are already in UHP.	UHA	Month 16	Plain-language letters reduce confusion but cost money and may still not reach confused or isolated seniors.