Surprise Administrative Decision Puts Millions at Risk of Losing Health Coverage

Julie CarterMedicare Watch0 Comments

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Last week, the Department of Justice (DOJ) asked a federal court in Texas to end the Affordable Care Act’s (ACA) protections for people with pre-existing conditions. The underlying legal challenge was filed earlier this year by 20 state attorneys general, who argue that without the individual mandate—which was eliminated in December’s Tax Cuts and Jobs Act—the entire is ACA unconstitutional. In an unexpected move, the DOJ declined to defend the ACA in this case, and instead asked the court to invalidate only the law’s provisions that prevent insurers from denying coverage or charging higher rates based on health status. Read More...

Tax Changes, Demographics, and Costs Trigger Changes in Medicare’s Financial Future

Casey SchwarzMedicare Watch0 Comments

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In its annual report to Congress, the Board of Trustees for Medicare said the program’s hospital insurance trust fund (Part A) could lack funds to pay full benefits by 2026—three years earlier than projected in last year’s report. Despite this finding, the Medicare program itself remains strong and sustainable. The trustees report identifies several factors that impact the balance of program funds. Read More...

Medicare Rights Opposes Potential New Medicare Model that Puts Beneficiaries at Risk

Julie CarterMedicare Watch0 Comments

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Last week, the Medicare Rights Center submitted comments to the Center for Medicare & Medicaid Innovation (CMMI) in response to a request for information on a potential new Medicare model. CMMI—an offshoot of the Centers for Medicare & Medicaid Services (CMS), which is the agency that oversees the Medicare program—was created to develop and test new ideas in health care delivery. Most of these ideas involve different ways of paying providers such as doctors or hospitals. In this request for information, CMMI asked interested parties to provide input on ways to design and test a model for Direct Provider Contracting (DPC). In a DPC model, a beneficiary could choose to join a primary care or specialty provider’s practice and potentially gain certain benefits such as reduced cost sharing or increased services that Medicare does not generally pay for. While this idea may be intriguing, CMMI did not provide any detail on how such a model would work, which leaves some dangerous options on the table. Read More...

CMS Expands the Extension of Needed Relief for Marketplace Enrollees Who Missed Medicare Enrollment

Mitchell ClarkMedicare Watch0 Comments

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This week, the Centers for Medicare & Medicaid Services (CMS) expanded the time-limited equitable relief opportunity to people who are enrolled in Marketplace plans but could have enrolled in Medicare Part B during their Special Enrollment Period (SEP), which was available to them after they lost their or a spouse’s job-based insurance. Read More...