The Medicare Payment Advisory Commission is actively evaluating whether to recommend the creation of a premium support program within the Medicare program.

The idea of a premium support plan, which has an ally in House Speaker Paul Ryan (R-WI), would let beneficiaries choose whether to receive Medicare through fee-for-service or a managed care plan, according to Bloomberg BNA. Medicare would pay a set amount. In Ryan’s plan, beneficiaries would receive a fixed subsidy.

Advocates say capping what the federal government pays would result in insurers developing — and beneficiaries choosing — more cost-effective healthcare. But while Medicare beneficiaries could avoid higher premiums in lower-cost premium support plans, it’s unclear whether a premium support system would ultimately shift costs back to seniors. That could pose challenges for those who need expensive long-term care at a skilled nursing facility.

Creating savings for both seniors and Medicare “may require that plans are structured to facilitate higher quality care and more cost-effective healthcare payment and delivery systems,” according to a 2013 report from the American Academy of Actuaries.

MedPAC’s report, which includes premium support recommendations, is expected in June.

In its meeting on Thursday, MedPAC commissioners also discussed whether drug manufacturers should be forced to report payments made to advance practice nurses and physician assistants. Experts said currently the Open Payments program is structured so that payments are shifted away from doctors to APNs and PAs due to their lack of reporting requirements, BNA reported.