Will the Trump Administration push more beneficiaries into Medicare Advantage managed care plans? Will the Administration limit payments to the insurance companies that run those plans? Will it do both? Whatever Trump does, the consequences will be significant for older adults and younger people with disabilities who rely on Medicare for their health care. Done well, an overhaul of MA [...]
Medicare Advantage prior authorizations have few friends. Doctors hate them. Patients hate them. Politicians say they hate them and introduce bills to curb them. But how onerous are they really? Less than many people think. But they still create opportunities for insurance companies to maximize profits at the expense of needed care. And they can be improved. Prior authorizations are [...]
President-elect Donald Trump prides himself on making deals. Here is one for him: Keep Joe Biden’s commitment to have Medicare pay for GLP-1 drugs such as Ozempic and Wegovy for weight loss. But only if the drugmakers agree to substantially reduce their prices right away. Such a move would be fraught for Trump and his Republican allies on multiple levels. [...]
The incoming Trump Administration has been sending mixed signals about the fate of Medicare. But if Trump advisers and GOP lawmakers are serious about slashing government spending it is hard to see how they will ignore the program, which last year cost $850 billion and accounted for about one out of every six dollars the federal government spent. Trump’s problem: [...]
Democratic presidential candidate Kamala Harris says she wants to create a home-based long-term care benefit under Medicare. She’s suggesting an historic change in the health care system for older adults and some younger people with disabilities. But her idea raises important political and policy questions. Harris describes the broad outlines of her plan in a hard-to-find fact sheet here. Oddly, [...]
Medicare expects it will spend more $550 million this year for the controversial anti-Alzheimer’s drug Leqembi and predicts the cost will skyrocket to $3.5 billion in 2025, according to Stat News. The program spent $5.7 billion on drugs such as Ozempic and Mounjaro in 2022, according to the Kaiser Family Foundation. These GLP-1 medications were designed to treat type 2 [...]
The Biden Administration has announced its list of the first 10 drugs that will be subject to price negotiations, a step allowed for the first time when Congress passed last year’s Inflation Reduction Act. The Pharmaceutical Manufacturers’ Association (PhRMA), the main drugmaker lobby, blasted the law. No surprise there. But its reasoning is evidence of how perverse the US health [...]
The federal agency that operates Medicare, the Centers for Medicare and Medicaid Services (CMS), is finally recognizing what families have known for, well, thousands of years: Family members are the bedrock of the system of care for frail older adults and younger people with disabilities. And the agency is taking some important steps to help them. Some proposals will provide [...]
In his budget due to be released tomorrow, President Biden will propose major changes in the way Medicare’s Part A hospital insurance program is funded. To ensure the program’s solvency, he’d shift hundreds of billions of dollars in tax revenues and allocate $200 billion in cost savings from other parts of Medicare to the hospital insurance (HI) trust fund. Biden’s [...]
Half of Medicare beneficiaries, about 30 million people, are enrolled in Medicare managed care plans such as Medicare Advantage (MA). And increasingly those plans are offering modest, but important, non-medical services to older adults living at home. These supplemental services are the only long-term care-type benefits most seniors will receive through Medicare. The assistance may include anything from meal and [...]