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.
Medicare Advantage enrollment has been on a steady climb for the past two decades following changes in policy designed to encourage a robust role for private plan options in Medicare.
When Californians phone for help with their Medicaid coverage, they routinely face waits of nearly an hour — and are regularly disconnected without reaching anyone, researchers found in a newly released analysis. An audit released Wednesday by the Children’s Partnership, an advocacy group focused on child health, found the average wait when researchers phoned in ...
On May 13, Sen. Bernie Sanders (I-Vt.) published an open letter to Novo Nordisk on the front page of a leading Danish newspaper, urging the hometown company to live up to its altruistic standards by lowering U.S. prices for its blockbuster diabetes and weight loss drugs. What Sanders didn’t realize was that Denmark, a country ...
The Centers for Medicare & Medicaid Services (CMS) is creating a voluntary demonstration program to support changes to Medicare Part D under the Inflation Reduction Act (IRA). The agency also finalized bid information for contract year 2025, with a base beneficiary premium increase of $2.08 for people with Part D. The IRA is designed to ...
Why OIG Did This Audit California pays managed care organizations to make services available to eligible Medicaid enrollees in return for a monthly fixed payment (capitation payment) for each enrollee. Previous OIG audits found that State Medicaid agencies made capitation payments on behalf of enrollees who were residing and enrolled in Medicaid in another State. ...
The government subsidy to Part D plans is shifting from being reconciled on the backend to a larger risk-adjusted payment upfront.
The Centers for Medicare & Medicaid Services (CMS) is creating a voluntary demonstration program to support changes to Medicare Part D under the Inflation Reduction Act (IRA). The agency also finalized bid information for contract year 2025, with a base beneficiary premium increase of $2.08 for people with Part D. The IRA is designed to ...
The Centers for Medicare & Medicaid Services (CMS) has released new data on risk adjustment payments for 2023. The agency said (PDF) insurers participating on the Affordable Care Act’s exchanges will pay $10.3 billion as part of the risk adjustment program. Risk adjustment state transfers as a percent of premiums declined from 2022, according to the report. ...
The Inflation Reduction Act calls for prescription drug prices for seniors on Medicare to be lowered and out-of-pocket expenses capped at $2,000 per year starting in 2025, the White House said. The act also capped the price of insulin, which helps regulate diabetes, at $35 a month for Medicare users.
The Wall Street Journal has added to the pressure on Medicare Advantage plan issuers by publishing its own analysis of how the issuers score their enrollees' health.