The politically polarized debate over the role of Medicare in deficit and debt reduction often ignores the accumulating evidence that the program can achieve significant spending reductions without sacrificing Medicare’s essential protections. We identify policies that correct long-standing gaps in financial protections that Medicare beneficiaries face, promote greater efficiency within payment systems, and recognize the need for additional revenues to pay for the impending surge in the number of beneficiaries in the program. Our illustrative package of reasonable Medicare policy options produces substantial budgetary savings, while preserving and, in some cases, enhancing the program for current and future beneficiaries. Together, these policies would provide savings or new revenues of about $600 billion after paying for permanent repeal of the SGR.