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Mitt Romney鈥檚聽plan to overhaul Medicare聽follows a familiar Republican prescription: Use the power of the marketplace to bring down costs and improve care. Yet, such a move would fundamentally change the nature of the popular program, and treads close to a proposal that Republicans were heavily criticized for earlier this year.

The GOP presidential candidate鈥檚 鈥減remium support鈥� plan would provide a set amount of money to beneficiaries, allowing them to shop around for health coverage.

Romney has promised that beneficiaries who like the current fee-for-service Medicare plan can opt for that instead of purchasing private insurance. He also says that all plans must offer coverage at least comparable to what Medicare provides today. But by giving beneficiaries the premium support, it is clear that Romney鈥檚 plan would move Medicare鈥檚 traditional program from one that pays a share of all medical bills a senior incurs to one that offers a fixed amount to buy insurance.聽

Keeping a traditional Medicare option helps differentiate Romney鈥檚 proposal from a聽 advanced earlier this year by Rep. Paul Ryan, R-Wis. By doing so, Romney counters critics who charged that Ryan鈥檚 plan would destroy a popular program that has protected millions of seniors from ever-growing health care costs.

鈥淲hen the president says you鈥檙e trying to get rid of Medicare he鈥檚 going to say, 鈥楴o I鈥檓 not,鈥欌�� said Robert Blendon, a professor at the Harvard School of Public Health.

Polls have shown that the public in general is split about a 鈥減remium support鈥� model, and seniors, an important voting bloc, strongly oppose it.聽 Noting the negative public reaction to Ryan鈥檚 plan, even some Republicans have distanced themselves from it.

Romney has given few specifics about his plan, which he聽 at a meeting of a conservative group Friday, but analysts said that鈥檚 not surprising.聽聽鈥淓very time we鈥檝e seen a Romney plan, it鈥檚 an appetizer that hedges the details,鈥� said Tom Miller, a resident fellow at the conservative-leaning American Enterprise Institute.聽

Romney, a former Massachusetts governor, has said that plans would compete on a combination of premium prices and benefits, and seniors could choose either a private health insurance policy or the government-run traditional Medicare plan. Enrollees could use their own money to obtain more generous benefits than the level supported by the government鈥檚 premium contribution. Romney鈥檚 plan would give lower-income and sicker seniors more money to purchase coverage, while wealthier seniors would receive less support.

A Familiar Concept

The idea of limiting government spending on Medicare and offering private plans isn鈥檛 exactly new. Seniors already can choose to obtain their health coverage through private Medicare Advantage plans, most of which are managed care plans and cover some benefits that traditional Medicare does not, including eyeglasses and hearing aids.

Medicare Advantage plans have seen growing enrollment in recent years, thanks in large part to their more generous benefit packages, but they still serve only about a quarter of Medicare鈥檚 48 million beneficiaries.

The lack of details in Romney鈥檚 plan leaves an array of possible scenarios for what it might mean to seniors in the future. It does not specify how much money the federal government would contribute to cover their premium costs, whether that support would rise enough each year to keep up with health care costs.

鈥淗e is exploring different options for ensuring that future seniors receive the premium support they need while also ensuring that competitive pressures encourage聽 providers to improve quality and control cost,鈥� according to an outline of Romney鈥檚 proposal.

To make traditional Medicare and private plans compete on equal footing, Medicare fee-for-service plans would have to change from the current standard premiums for Part B coverage for doctor bills and other outpatient services to premiums that vary from one region of the country to another, as private insurance premiums do, said James Capretta, a fellow at the Ethics and Public Policy Center, a conservative think tank. 鈥淵ou鈥檝e got to break it a little bit more into more of a region-by-region competition,鈥� he said.

Miller agreed that fee-for-service can only be competitive with private plans if it is broken into smaller, regional units.聽 鈥淟ump together some of the smaller states and allow them to have some operating authority,鈥� he said. If they can鈥檛 operate within their budget, he said, allow them to adjust cost-sharing and establish more restrictive networks of doctors, hospitals and other medical providers.

Who Benefits?

Ron Pollack, executive director of the consumer group Families USA, predicted that Medicare鈥檚 oldest and sickest beneficiaries would be worse off under Romney鈥檚 plan. With limits on the government鈥檚 contributions for premiums, seniors could end up with fewer benefits for the same or higher costs, he said.

While younger, healthier seniors would move to private plans, some of which would have lower premiums than traditional Medicare plans, older and sicker people would remain with fee-for-service because it is what they are used to and they want the guarantee of comprehensive benefits, even if they have to pay more for it, Pollack predicted.

鈥淎 defined contribution system provides little guarantee about what benefits are covered,鈥� he said. 鈥淵ou can鈥檛 reduce spending in Medicare unless the benefits are somewhat less, or the contribution provided by the government, as a percent of total costs, diminishes over time.鈥澛� If the government鈥檚 share goes down, the beneficiary鈥檚 will go up.

Joe Baker, president of the Medicare Rights Center, a N.Y.-based consumer advocacy group, discounts Romney鈥檚 claims that having more seniors in private plans will save Medicare money. The Medicare Advantage program, he said, 鈥渉as not brought down costs, so to think that there鈥檚 a new version that willy nilly by itself will bring down costs is a fantasy鈥�.It鈥檚 really cover for the real goal, and that is to end Medicare as we know it and by doing that, have more money come out of the pockets of consumers and save the federal government money.鈥�

A Congressional Budget Office analysis projected that under Ryan鈥檚 Medicare plan, by 2030 a typical 65-year old would be required to pay 68 percent of the total cost of his or her Medicare-covered services. That compares with the 25 percent they would pay under current law.

How much beneficiaries would have to pay under the Romney plan would depend on its details.

In addition to transforming Medicare into a premium support program, Romney would raise the program鈥檚 eligibility age to reflect the fact that Americans are living longer. But he has premised all of his changes on first repealing the 2010 health law.

That could leave some retirees without health coverage, because older people are more likely than younger ones to have chronic, pre-existing medical conditions. Without the health law鈥檚 requirement that insurers cover most people, many could not obtain affordable coverage.

鈥淚f you eliminate the Affordable Care Act, it means that 65 and 66 year olds won鈥檛 have that resource. The result will be a substantial number of people joining the ranks of the uninsured. Many of these folks are retired and have moderate incomes, so this is going to be a huge setback for a large number of 65 and 66 year olds who would lose coverage,鈥� Pollack said.

UPDATED: This story was updated to add that Romney says all plans must offer coverage at least comparable to what Medicare provides today.