About 115 pages into President Trump's proposed 2021 budget are two line items that Medicare beneficiaries might want to take note of. While the president's proposals pertaining to Medicare are largely aimed at behind-the-scenes shifts — i.e., lowering reimbursement rates to providers and rooting out waste or fraud — the budget also includes changes that would make it easier for older Americans to opt out of Medicare and would allow recipients to put money in tax-advantaged accounts earmarked for health-care costs. Trump's budget is essentially a rundown of administration priorities and goals versus a mandate, and any changes in funding or to the program would need to make it through Congress. And while details are slim regarding either of these changes — and how they would interact with existing rules — here's the gist of the two line items (which are found under the heading "Reduce government-imposed burden in Medicare").

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Opting out of Medicare Part A

The first proposal would allow individuals to opt out of Medicare Part A (hospital coverage) without the move interfering with their Social Security benefits. The proposal isn't a new one. A court case from a decade ago challenged the rule, and is supported in some conservative circles. Currently, if you start taking Social Security before age 65, you automatically get signed up for Part A when you hit that Medicare-eligible age. Waiting until after age 65 to tap Social Security results in automatic sign-up, as well. And while you could choose to opt out of Part B (outpatient care) if you have coverage elsewhere, you must remain enrolled in Part A or pay a steep price.

"The only way they can opt out of Part A is either not to apply for Social Security in the first place or, if they already have, repay the Social Security Administration all the money they've received and anything Medicare has spent on their health care," said Medicare expert Patricia Barry, author of "Medicare for Dummies." She explained that the rule has been around since the program's beginnings, when most people retired at age 65 and started both Social Security and Medicare at that time. Meanwhile, although Part A is free as long as you have at least a 10-year work history of contributing to the program through payroll taxes, it can also cause snags if your other insurance is a high-deductible health plan with a health savings account, or HSA. That's because under current rules, you cannot contribute to an HSA if you are on Medicare, even if only Part A (more on that below). The budget notes that the change would have no effect on revenue.

Contributing to HSAs