Medicare & Medicaid
News articles in this section include actions by federal regulators like the CMS and HHS, as well as information on Medicare and state Medicaid coverage and benefits.
The election’s outcome could alter the very nature of the nearly 60-year-old federal program. More than half of Medicare beneficiaries are already enrolled in plans, called Medicare Advantage, run by commercial insurers.
Physicians will see their Medicare reimbursement fall 2.9% next year if Congress doesn’t stop the cuts. Meanwhile, reimbursement for hospital outpatient departments is rising 2.9%.
Will any legislation surrounding prior authorization, price transparency or individual coverage health reimbursement arrangements (ICHRAs), for example, make it in an end-of-year package? Movement on new electronic prior auth standards may be possible, we learned.
CMS payment model changes, rising costs and higher utilization. In addition to these Medicare Advantage (MA) stories, which have dominated 2024, the past few weeks have been a cornucopia of new headlines. Their alternate versions might read: When stock value trumps vision. The ouster of CEO Karen Lynch at CVS Health, the possible break-up of its business ...
When Pam McClure learned she’d save nearly $4,000 on her prescription drugs next year, she said, “it sounded too good to be true.” She and her husband are both retired and live on a “very strict” budget in central North Dakota. By the end of this year, she will have spent almost $6,000 for her ...
Research shows about half of U.S. adults say they cannot afford their health care costs. According to an AARP Research study, healthcare affordability, rising health insurance costs and a lack of confidence in affording unexpected medical bills are significant concerns for adults ages 40 to 64.
There will be a major change to Medicare Part D in 2025 with the “doughnut hole,” or coverage gap going away. The maximum out-of-pocket cost for Part D prescriptions in 2025 will be $2,000.
In its estimates released Tuesday, CBO said 12.5 million Medicare beneficiaries would qualify for the medications beginning in 2026, and 2 percent would be expected to use the drugs in the first year.
Attention, Medicare Advantage enrollees: It’s a good idea to review your plans during open enrollment, which begins Tuesday, so you don’t get caught by surprise next year. Although the swiftly growing market remains stable overall, insurers are making a flurry of changes that could leave some senior citizens hunting for new policies, paying more out ...
The Centers for Medicare & Medicaid Services (CMS) rolled out guidance Oct. 2 as stakeholders prep for the second round of the drug price negotiation program. Made possible through the Inflation Reduction Act, the federal government has praised the program, saying it drastically lowers the cost of lifesaving drugs. The negotiation period for the first ...